中西医结合肝病杂志2026，Vol.36Issue(2)：154-158,5.DOI:10.3969/j.issn.1005-0264.2026.002.005
颈静脉肝内门体分流术治疗肝硬化顽固性腹水疗效的影响因素及疗效预测模型构建
Factors influencing the efficacy of TIPS in the treatment of refractory ascites in liver cirrhosis and construction of a predictive model for efficacy
摘要
Abstract
Objective:To analyze the influencing factors of the curative effect of transjugular intrahepatic portosystemic stent shunt(TIPS)in the treatment of refractory ascites in cirrhosis,and to construct a predictive curative model.Methods:360 patients with refractory ascites due to liver cirrhosis treated with TIPS(admitted to our hospital)were selected and randomly divided into a modeling group(252 cases)and a validation group(108 cases)based on a simple randomization method.The data of the patients were collected,and the patients were followed up for 1 year.They were grouped into the survival group and the death group according to the survival situation,and the factors affecting the efficacy of the patients were analyzed(univariate and multivariate Cox analysis).Using receiver operating characteristic(ROC)curve and calibration curve analysis to validate the predictive value of the column chart model.Results:After treatment,the patients were followed up for 1 year,156 cases(61.9％)survived,and 96 cases(38.1％)died.Univariate analysis showed that age,Child-Pugh score,MELD score and ascites volume were the factors affecting the efficacy of TIPS in the treatment of refractory ascites in cirrhosis(P＜0.05);four different variables including age,Child-Pugh score,model for end-stage liver disease(MELD)score and ascites volume were included in the multivariate analysis,and it was shown that older age,higher Child-Pugh score,higher MELD score and more ascites volume were independent risk factors affecting the efficacy of TIPS in the treatment of refractory ascites in liver cirrhosis(P＜0.05).R software was used to build a prediction model,and the H-L fit curve was drawn to evaluate the validity of the model,and the results showed that the modeling group x2=7.569,P=0.457;the validation group x2=6.754,P=0.356.The ROC curve was drawn to evaluate the discrimination of the model,the results showed that the area under the ROC curve of the modeling group was 0.904(95％CI:0.861-0.937),and the sensitivity and specificity were 80.21％and 87.18％,respectively.The area under the ROC curve of the validation group was 0.854(95％CI:0.804-0.895),and the sensitivity and specificity were 81.25％and 72.44％,respectively.Conclusion:Older age,higher Child-Pugh score,higher MELD score and more ascites are independent risk factors that affect the efficacy of TIPS for refractory ascites.The nomogram constructed in this way can be used as an effective tool to clinically predict the efficacy of TIPS in the treatment of refractory ascites in cirrhosis.关键词
肝硬化顽固性腹水/颈静脉肝内门体分流术/疗效预测/预测模型Key words
refractory ascites in cirrhosis/transjugular intrahepatic portosystemic stent shunt/efficacy prediction/predictive model分类
医药卫生引用本文复制引用
向波,王勤,李洪焱..颈静脉肝内门体分流术治疗肝硬化顽固性腹水疗效的影响因素及疗效预测模型构建[J].中西医结合肝病杂志,2026,36(2):154-158,5.基金项目
2019年四川医学青年创新科研课题(No.Q19033) （No.Q19033）
