临床肝胆病杂志2024，Vol.40Issue(7)：1375-1381,7.DOI:10.12449/JCH240715
肝硬化自发性脾肾分流治疗后再出血及5年生存率的影响因素分析
Influencing factors for rebleeding and 5-year survival rate after treatment in patients with liver cirrhosis and spontaneous splenorenal shunt
摘要
Abstract
Objective To investigate the influencing factors for rebleeding and 5-year survival rate after treatment in patients with liver cirrhosis and spontaneous splenorenal shunt(SSRS),and to provide a basis for clinical prognostic assessment.Methods A total of 95 patients with liver cirrhosis and SSRS who were admitted to Zhongshan Hospital and Xiamen Branch of Fudan University from June 2014 to June 2018 were enrolled,and all patients were followed up for at least 5 years.According to the presence or absence of gastrointestinal bleeding during follow-up,the patients were divided into rebleeding group with 27 patients and non-rebleeding group with 68 patients.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous between two groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.Univariate and multivariate Cox regression analyses were used to investigate the influencing factors for the prognosis of patients with SSRS,and the Kaplan-Meier method was used to describe survival outcomes.A Pearson or Spearman correlation analysis was performed.Results Compared with the non-rebleeding group,the rebleeding group had significantly higher splenorenal shunt diameter[4.60(3.20—5.90)mm vs 3.45(2.10—5.45)mm,Z=1.973,P=0.048]and hepatic venous pressure gradient(18.57±6.60 mmHg vs 15.06±5.82 mmHg,t=2.280,P=0.026)and a significantly lower portal vein diameter(14.04±2.90 mm vs 15.45±2.90 mm,t=2.138,P=0.035).The correlation analysis showed that splenorenal shunt diameter was negatively correlated with portal vein diameter(rs=-0.211,P=0.040).Adverse events within 5 years after treatment included rebleeding(27.4%),portal vein thrombosis(11.6%),infection(4.2%),cerebral hemorrhage(1.1%),and cerebral infarction(1.1%).Splenorenal shunt diameter(risk ratio[RR]=1.173,95%confidence interval[CI]:1.001—1.374,P=0.048)and superior mesenteric vein diameter(RR=0.844,95%CI:0.746—0.956,P=0.007)were independent influencing factors for gastrointestinal rebleeding within 5 years after treatment.Bilirubin(RR=1.028,95%CI:1.010—1.046,P=0.002)and blood urea nitrogen(RR=1.347,95%CI:1.116—1.625,P=0.002)were independent risk factors for 5-year survival rate after treatment.Conclusion Splenorenal shunt diameter is closely associated with the prognosis of cirrhotic patients,and it is recommended to enhance imaging follow-up of splenorenal shunt diameter for cirrhotic patients with SSRS.关键词
肝硬化/脾肾分流/预后Key words
Liver Cirrhosis/Splenorenal Shunt/Prognosis引用本文复制引用
翁成钊,蒋炜,陈世耀,郑琳琳..肝硬化自发性脾肾分流治疗后再出血及5年生存率的影响因素分析[J].临床肝胆病杂志,2024,40(7):1375-1381,7.基金项目
国家自然科学基金(82370622) （82370622）
福建省自然科学基金重点项目(2021D033) （2021D033）
福建省医学创新课题(2022CXB020) （2022CXB020）
厦门市医疗卫生指导性项目(3502Z20209046)National Natural Science Foundation of China(82370622) （3502Z20209046）
Key Project of Natural Science Foundation of Fujian Province(2021D033) （2021D033）
Medical Innovation Project of Fujian Province(2022CXB020) （2022CXB020）
Guiding Project of Medical and Health Care of Xiamen City(3502Z20209046) （3502Z20209046）
