Viatorr支架经颈静脉肝内门体分流术后显性肝性脑病发生率及其危险因素分析

Overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with Viatorr stent:analysis of its incidence and risk factors

目的分析应用Viatorr覆膜支架行经颈静脉肝内门体分流术(TIPS)后患者显性肝性脑病(OHE)发生率并探讨相关危险因素。方法收集2017年6月至2019年12月在南方医科大学附属南方医院接受Viatorr支架TIPS术治疗的242例肝硬化门静脉高压患者(男191例,女51例)临床资料。术后发生OHE 30例,未发生OHE 212例。统计分析两组患者年龄、乙型肝炎病史及腹水、血清总胆红素、白蛋白、肌酐、血小板、钠离子、纤维蛋白原、肝功能Child-Pugh评分、终末期肝病模型(MELD)评分、术后1 d和5 d血氨、术后门静脉压力梯度(PPG)、出院后饮食控制等。所有患者均随访3个月以上,通过门诊或电话问卷方式评估肝性脑病(HE)。结果术后OHE发生率为12.4%(30/242),其中7例因OHE死亡。发生OHE组患者平均年龄高于未发生OHE组,术后平均PPG值低于未发生OHE组,差异均有统计学意义(P<0.05)。高蛋白饮食控制不佳的OHE患者发病次数增多。结论应用Viatorr覆膜支架对肝硬化门静脉高压患者行TIPS术后发生OHE的独立危险因素为高龄、术后低PPG,其预测价值高于Child-Pugh评分和MELD评分。逐级扩张分流道和栓塞异常门体分流有助于降低OHE发生率。

Objective To investigate the incidence of overt hepatic encephalopathy(OHE) after transjugular intrahepatic portosystemic shunt(TIPS) by using Viatorr stent(a special covered stent), and to analyze its relevant risk factors. Methods The clinical data of a total of 242 patients, including 191 males and 51 females, with cirrhotic portal hypertension, who were admitted to the Affiliated Nanfang Hospital of Southern Medical University of China to receive TIPS by using Viatorr stent between June 2017 and December 2019,were retrospectively collected. Depending on whether a postoperative OHE had occurred or not, the patients were divided into OHE group(n=30) and non-OHE group(n=212). The age, history of hepatitis B and ascites,serum total bilirubin, albumin, creatinine, platelet, sodium ion, fibrinogen, liver function Child-Pugh score,end-stage liver disease model(MELD) score, postoperative one-day and 5-day blood ammonia, postoperative portal vein pressure gradient(PPG), post-discharge dietary control, etc. in both groups were calculated and analyzed. All the patients were followed up for more than 3 months. The evaluation of OHE was made through outpatient visit or through telephone questionnaire method. Results The postoperative incidence of OHE was12.40%(30/242). Among the 30 OHE patients,7 died of OHE. The mean age in OHE group was obviously higher than that in non-OHE group, while the postoperative mean PPG in OHE group was remarkably lower than that in non-OHE group;the differences in the above two items between the two groups were statistically significant(P<0.05). In patients, in whom the high-protein diet was poorly controlled, the onset of OHE was more frequent. Conclusion In patients with cirrhotic portal hypertension who are treated with TIPS by using Viatorr covered stent, the independent risk factors for postoperative OHE are old age and low postoperative PPG, and their value in predicting postoperative OHE is higher than that of Child-Pugh score and MELD score. Gradual dilation for shunt channel and complete embolization of abnormal portosystemic collateral branches are helpful for reducing the incidence of postoperative OHE.(J Intervent Radiol, 2021, 30: 998-1002)