摘要
背景:经颈静脉肝内门体静脉分流术(TIPS)对于肾功能的影响以及TIPS之后血肌酐(Cr)水平与病死率的关系仍然不明。本研究旨在评估TIPS对肾功能的影响,以及TIPS治疗后Cr水平与死亡风险的关系。方法:2004-2017年间接受TIPS治疗的593例患者被纳入研究。收集TIPS术前7天内(T0)以及术后12天(T1)、512天(T2)、1540天(T3)的Cr水平。采用多变量线性回归和Cox比例风险模型评估TIPS后Cr水平对1年死亡率的预测价值。结果:593例患者中,127例(21.4%)基础Cr水平升高(≥1.5 mg/dL;平均2.51˘1.49 mg/dL),466例(78.6%)基础Cr水平正常(<1.5 mg/dL;平均0.92˘0.26 mg/dL)。TIPS术前Cr水平升高的患者TIPS之后Cr水平显著降低(0.60 mg/dL),而TIPS术前Cr水平正常的患者TIPS之后Cr水平无明显变化(<0.01 mg/dL)。全组患者TIPS之后30天、90天及1年死亡率分别为13%、20%和32%。静脉曲张出血、T0 Cr高水平及T3高Cr水平是1年死亡率的独立危险因素。结论:对于基础肾功能不全的患者,TIPS可改善其肾功能。TIPS之后Cr水平是1年死亡风险的有效预测指标。
Background:The effect of transjugular intra-hepatic portosystemic shunt(TIPS)placement on renal function and the correlation of post-TIPS Cr with mortality remain unclear.This study aimed to assess the effect of TIPS placement on renal function and to examine the relationship between post-TIPS Cr and mortality risk.Methods:A total of 593 patients who underwent de novo TIPS placement between 2004 and 2017 at a single institution were included in the study.The pre-TIPS Cr level(T0;within 7 days before TIPS placement)and post-TIPS Cr levels,at 1–2 days(T1),5–12 days(T2),and 15–40 days(T3),were collected.Predictors of Cr change after TIPS placement and the 1-year mortality rate were analysed using multivariable linear-regression and Cox proportional-hazards models,respectively.Results:Overall,21.4%of patients(n=127)had elevated baseline Cr(≤1.5 mg/dL;mean,2.5161.49 mg/dL)and 78.6%(n=466)had normal baseline Cr(<1.5 mg/dL;mean,0.9260.26 mg/dL).Patients with elevated pre-TIPS Cr demonstrated a decrease in post-TIPS Cr(difference,-0.60 mg/dL),whereas patients with normal baseline Cr exhibited no change(difference,<0.01 mg/dL).The 30-day,90-day,and 1-year mortality rates were 13%,20%,and 32%,respectively.Variceal bleeding as a TIPS-placement indication(hazard ratio=1.731;P=0.036),higher T0 Cr(hazard ratio=1.834;P=0.012),and higher T3 Cr(hazard ratio=3.524;P<0.001)were associated with higher 1-year mortality risk.Conclusion:TIPS placement improved renal function in patients with baseline renal dysfunction and the post-TIPS Cr level was a strong predictor of 1-year mortality risk.
