[1]高西杰,赵剑波,谭 卿,等.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[J].介入放射学杂志,2021,30(10):998-1002.
　GAO Xijie,ZHAO Jianbo,TAN Qing,et al.Overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with Viatorr stent： analysis of its incidence and risk factors[J].journal interventional radiology,2021,30(10):998-1002.
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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()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
30
期数:
2021年10
页码:
998-1002
栏目:
血管介入
出版日期:
2021-10-25

文章信息/Info

Title:
Overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with Viatorr stent： analysis of its incidence and risk factors
作者:
高西杰;  赵剑波;  谭 卿;  彭琦峰;  高一平;  王江云
Author(s):
GAO Xijie;  ZHAO Jianbo;  TAN Qing;  PENG Qifeng;  GAO Yiping;  WANG Jiangyun.
Department of Interventional Diagnosis and Treatment， Wanning Municipal People’s Hospital， Wanning， Hainan Province 571500， China
关键词:
【关键词】 经颈静脉肝内门体分流术;  Viatorr覆膜支架;  显性肝性脑病
文献标志码:
A
摘要:
【摘要】 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。

参考文献/References:

［1］ Angeloni S， Merli M， Salvatori FM， et al. Polytetrafluoroethylene-covered stent grafts for TIPS procedure： 1- year patency and clinical results［J］. Am J Gastroenterol， 2004， 99：280-285.
［2］ Barrio J， Ripoll C， Banares R， et al. Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE- covered stent-grafts versus bare stents［J］. Eur J Radiol， 2005， 55：120-124.
［3］ 王 重， 刘福全. 经颈静脉肝内门体分流术后肝性脑病的研究进展［J］. 临床肝胆病杂志， 2019， 35：2824-2827.
［4］ 王结实. 门-体分流术后并发肝性脑病的危险因素分析［J］. 中国实用神经疾病杂志， 2017， 20：111-113.
［5］ Riggio O， Angeloni S， Salvatori FM， et al. Incidence， natural history， and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts［J］. Am J Gastroenterol， 2008， 103：2738-2746.
［6］ 中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南（2019年版）［J］. 临床肝胆病杂志， 2019， 35：2694-2699.
［7］ Atterbury CE， Maddrey WC， Conn HO. Neomycin- sorbitol and lactulose in the treatment of acute portal- systemic encephalopathy. A controlled， double- blind clinical trial［J］. Am J Dig Dis， 1978， 23： 398-406.
［8］ 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南［J］. 临床肝胆病杂志， 2018， 34：2076-2089.
［9］ Bajaj JS， Cordoba J， Mullen KD， et al. Review article： the design of clinical trials in hepatic encephalopathy：an International Society for Hepatic Encephalopathy and Nitrogen Metabolism（ISHEN） consensus statement［J］. Aliment Pharmacol Ther， 2011， 33： 739-747.
［10］ Pereira K， Carrion AF， Martin P， et al. Current diagnosis and management of post- transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy［J］. Liver Int， 2015， 35：2487-2494.
［11］ Schepis F， Vizzutti F， Garcia-Tsao G， et al. Under- dilated TIPS associate with efficacy and reduced encephalopathy in a prospective， non- randomized study of patients with cirrhosis［J］. Clin Gastroenterol Hepatol， 2018， 16：1153-1162.
［12］ Trebicka J，Bastgen D，Byrtus J，et al. Smaller- diameter covered transjugular intrahepatic portosystemic shunt stents are associated with increased survival［J］. Clin Gastroenterol Hepatal， 2019，17：2793.e1-2799.e1.
［13］ Kraglund F，Jepsen P，Amanavicius N，et al. Longterm effects and complications of the transjugular intrahepatic portosystemic shunt：a singal- centre experience［J］. Scand J Gastroenterol， 2019， 54899- 904.
［14］ Fonio P，Discazil A，Calandri M，et a1． Incidence of hepatic ence-phalopathy after transjugular intrahepatic portosystemic shunt（TIPS） according to its severity and temporal grading classification［J］．Radiol Med， 2017， 122：713-721.
［15］ Miraglia R， Maruzzelli L，Di Piazza A，et al. Transjugular intrahe-patic portosystemic shunt using the new gore Viatorr controlled expansion endoprosthesis： prospective， single- center， preliminary experience［J］. Cardiovasc Intervent Radiol， 2019， 42：78- 86.
［16］ Perarnau JM， Le Gouge A， Nicolas C， et a1． Covered vs uncovered stents for transjugular intrahepatic portosystemic shunt： a randomized controlled trial［J］． J Hepatol， 2014， 60：962-968.
［17］ 孙旻煌， 李迎春， 李松蔚， 等. Viatorr支架在TIPS治疗中的应用［J］. 介入放射学杂志， 2019， 28：68-71.
［18］ 鲍应军， 顾俊鹏， 张海潇， 等. 采用Viatorr支架行TIPS治疗门静脉高压症疗效［J］. 中国介入影像与治疗学， 2019， 16：17-20.
［19］ Tan HK， James PD， Sniderman KW， et al. Long-term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion［J］. J Gastroenterol Hepatol， 2015，30： 389-395.
［20］ Zhou L， Zhong B，DU H，et al. Comparison of embolic agents for varices during transjugular intrahepatic portosystemic shunt for variceal bleeding： tissue gel or coil?［J］. J Intervent Med， 2020， 3：195-200.
［21］ Vilstrup H， Amodio P， Bajaj J， et al. Hepatic encephalopathy in chronic liver disease： 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver［J］. Hepatology， 2014， 60：715-735.

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备注/Memo

备注/Memo:
（收稿日期：2021-03-21）
（本文编辑：边 佶）
更新日期/Last Update: 2021-10-13