内镜及TIPS治疗特发性非肝硬化门脉高压并静脉曲张出血的长期效果及预后分析

Long-term outcome and prognostic factors of endoscopic or transjugular intrahepatic portosystemic shunt for idiopathic non-cirrhotic portal hypertension with variceal bleeding patients

目的探讨内镜及经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗特发性非肝硬化门脉高压症(idiopathic non-cirrhotic portal hypertension,INCPH)患者静脉曲张出血后的长期临床效果及预后影响因素。方法回顾性分析2000年1月-2013年12月在西安市中心医院行内镜(内镜组)或TIPS(TIPS组)治疗的INCPH静脉曲张出血患者的临床资料,规律随访观察再出血及生存情况。结果在随访时间内,共有12例患者出现静脉曲张再出血,1年、2年、4年再出血率分别是5.0%、10.7%和38.3%,两组比较,差异无统计学意义(P=0.7445)。共有8例INCPH患者死亡,所有患者的1年、2年、4年生存率分别为97.4%、92.2%、78.2%,两组比较,差异无统计学意义(P=0.645)。年龄(HR=1.974,P=0.038)和Child-Pugh评分(HR=2.462,P=0.034)是预测患者生存的独立危险因素。结论内镜与TIPS可有效预防INCPH患者的静脉曲张再出血,且患者有较高的生存率。

Objective To investigate the long-term clinical outcome and prognostic factors of endoscopic or transjugular intrahepatic portosystemic shunt（ TIPS） for idiopathic non-cirrhotic portal hypertension（ INCPH） with variceal bleeding. Methods The clinical data of INCPH with variceal bleeding patients under endoscopy or TIPS treatment from Jan. 2000 to Dec. 2013 in Xi＇an Central Hospital were collected and analyzed respectively. Regular follow-up was performed to observe rebleeding rate and survival condition. Results During follow-up,12 patients occurred rebleeding.Rebleeding rates of 1,2 and 4-year were 5.0%,10.7% and 38.3%,respectively,the variceal rebleeding rate between endoscopic group and TIPS group was no significant difference（ P = 0.7445）. Eight patients died,and the survival rates of 1-,2-and 4-year were 97.4%,92.2% and 78.2%,respectively,and there was no significant difference in survival rate between two groups（ P = 0. 645）. The multivariate analysis showed that age（ HR = 1.974,P = 0. 038） and ChildPugh score（ HR = 2.462,P = 0.034） were independent predictors for survival. Conclusion Endoscopy and TIPS could effectively prevent rebleeding in patients with INCPH with variceal bleeding.