血小板减少症患者经颈静脉肝内门体分流术安全性和预后分析

TIPS in patients with thrombocytopenia:analysis of clinical safety and prognosis

目的探讨肝硬化门静脉高压伴血小板减少症患者接受经颈静脉肝内门体分流术(TIPS治疗的安全性和预后。方法回顾性选取2015年11月至2021年5月在武汉协和医院接受TIPS术治疗的229例门静脉高压患者,根据术前患者血小板计数(PLT)分为重度血小板减少组(PLT<40×10^(9)/L,n=44)和轻度血小板减少组(PLT 40~100×10^(9)/L,n=185)。绘制术后肝肾功能折线图,采用Kaplan-Meier曲线分析比较两组患者临床预后。结果所有患者均成功实施TIPS术,技术成功率为100%。围手术期无严重并发症发生。重度血小板减少组、轻度血小板减少组术前平均PLT分别为(30.5±7.7)×10^(9)/L、(65.1±16.9)×10^(9)/L,术后肝肾功能指标变化趋势无显著差异。随访期间,重度血小板减少组、轻度血小板减少组1年支架功能障碍发生率分别为2.4%、6.9%,2年支架功能障碍发生率分别为5.9%、11.4%,两组间差异无统计学意义(HR=0.80,95%CI=0.25~2.52,Log-rank P=0.723);两组间累积生存率(Log-rank P=0.685)、再出血或再发腹水率(Log-rank P=0.357)和显性肝性脑病发生率(Log-rank P=0.753)差异均无统计学意义。结论对凝血功能正常或轻度异常(凝血酶原时间延长不超过5 s)的血小板减少症(PLT>20×10^(9)/L)患者行TIPS术是安全的,血小板减少症严重程度与经TIPS治疗肝硬化门静脉高压患者预后无关。

Objective To investigate the clinical safety and prognosis of transjugular intrahepatic portosystemic shunt(TIPS)in patients with cirrhotic portal hypertension(PH)complicated by thrombocytopenia.Methods A total of 229 patients with PH,who received TIPS at Wuhan Union Hospital of China between November 2015 and May 2021,were retrospectively collected.Based on the preoperative platelet count(PLT)level,the patients were divided into severe thrombocytopenia group(group S,PLT<40×10^(9)/L,n=44)and mild thrombocytopenia group(group M,PLT 40-100×10^(9)/L,n=185).A line chart of postoperative liver and kidney functions was drawn,and Kaplan-Meier curve was used to compare the clinical prognosis between the two groups.Results All patients were successfully treated with TIPS,the technical success rate was 100%.No serious complications occurred during perioperative period.The average preoperative PLT levels in group S and group M were(30.5±7.7)×10^(9)/L and(65.1±16.9)×10^(9)/L respectively.There was no significant difference in the variation tendency of liver and kidney function indexes between the two groups after TIPS.During the follow-up period,in group S and group M the one-year stent dysfunction rates were 2.4%and 6.9%respectively,and the 2-year stent dysfunction rates were 5.9%and 11.4%respectively,the differences between the two groups were not statistically significant(HR=0.80,95%CI=0.25-2.52,Log-rank P=0.723).No statistically significant differences in cumulative survival(Log-rank P=0.685),recurrence of bleeding or ascites(Log-rank P=0.357),and incidence of overt hepatic encephalopathy(Log-rank P=0.753)existed between the two groups.Conclusion For patients with thrombocytopenia(PLT>20×10^(9)/L),whose coagulation function is normal or slightly abnormal(the extension of prothrombin time<5 seconds),TIPS is clinically safe.The severity of thrombocytopenia bears no relationship to the prognosis in patients with cirrhotic PH treated with TIPS.(J Intervent Radiol,2022,31:765-769)