本文選題：腹水 + 頑固性　； 參考：《重慶醫(yī)科大學(xué)學(xué)報》2015年03期

【摘要】：目的:探討經(jīng)頸靜脈肝內(nèi)門體分流術(shù)(transjugular intrahepatic portosystemic shunt,TIPS)治療肝硬化頑固性腹水的臨床療效及影響預(yù)后因素。方法:23例肝硬化頑固性腹水患者術(shù)后隨訪1~26月(平均9.7月),觀察患者腹水緩解情況(腹水量)、臨床血清學(xué)指標(血小板計數(shù)、白蛋白、總膽紅素、凝血酶原時間、肌酐等)、生存率等。采用配對t檢驗、非參數(shù)檢驗分析術(shù)前術(shù)后臨床血清學(xué)指標的變化情況,Kaplan-Merier方法計算生存率,術(shù)前危險因素預(yù)測3個月腹水療效采用logistic回歸分析,術(shù)前危險因素對術(shù)后生存情況的影響采用COX多因素回歸模型分析,受試者工作曲線(receiver operating characteristic,ROC)及曲線下面積(area under the curve,AUC)判斷最佳預(yù)測界值。結(jié)果:術(shù)后1年的各個隨訪期患者的腹水與術(shù)前比較明顯改善,82.6%的患者術(shù)后1月腹水得到有效控制,52.4%患者在術(shù)后3月僅存少量腹水,術(shù)后6月在訪的所有患者腹水均為少量。術(shù)后1周肝功能存在短期損害凝血酶原時間延長,中值(最小值,最大值)=19.6(14.0,28.7),Z=-2.419,P=0.016;Child-Pugh評分增加,x±s=9.87±1.71,t=-2.714,P=0.013;總膽紅素升高,Z=-3.711,P=0.000,中值(最小值,最大值)=37.0(13.2,204.3),之后逐漸恢復(fù)。術(shù)后3個月、6個月及1年的累積生存率為95.5%、85.9%、78.1%。COX回歸多因素分析顯示血鈉(P=0.027,HR=0.677,95%CI=0.479~0.956)、總膽紅素(P=0.007,HR=1.049,95%CI=1.012~1.086)是影響預(yù)后的獨立危險因素。運用ROC及AUC分析提示總膽紅素AUC為0.676,95%CI為0.335~1.000,總膽紅素37μmol/L(敏感性66.7%,特異性94.1%)為最佳預(yù)測界值。Kaplan-Merier生存率分析顯示總膽紅素≥37μmol/L及總膽紅素37μmol/L時的1年生存率分別為25%、92.3%。結(jié)論:TIPS是治療肝硬化頑固性腹水的有效方案,術(shù)后存在短期的肝功能損害;總膽紅素≥37μmol/L是預(yù)測肝硬化頑固性腹水患者TIPS術(shù)后1年生存率的危險因素,可為術(shù)前判斷患者預(yù)后提供臨床依據(jù)。
[Abstract]:Objective: to investigate the clinical effect and prognostic factors of (transjugular intrahepatic portosystemic shunttips in the treatment of refractory ascites of liver cirrhosis by transjugular intrahepatic portosystemic shunt (transjugular intrahepatic portosystemic shunttips). Methods Twenty three patients with refractory ascites of liver cirrhosis were followed up for 1 ~ 26 months (mean 9.7 months). The clinical serological parameters (platelet count, albumin, total bilirubin, prothrombin time), ascites remission (ascites volume) and clinical serological parameters (platelet count, albumin, total bilirubin, prothrombin time) were observed. Creatinine, etc.), survival rate, etc. The survival rate was calculated by Kaplan-Merier method with paired t test and nonparametric test. The preoperative risk factors were used to predict the effect of ascites for 3 months. Logistic regression analysis was used. The influence of preoperative risk factors on postoperative survival was analyzed by Cox multivariate regression model. The optimal predictive bounds were determined by the operating curve (receiver operating) and the area under the curve (area under the curveAUC). Results: the ascites of each follow-up period were significantly improved in 82.6% of the patients at 1 month after operation. 52.4% of the patients had only a small amount of ascites at 3 months after operation, and only a small amount of ascites were found in all the patients in 6 months after operation. At 1 week after operation, there were short-term damage to prothrombin time, the median value (minimum value, maximum value) was 19.6 (14.0 / 28.7) and the Child-Pugh score increased by x 鹵s 9.87 鹵1.71 ~ 1.71 ~ (-1) ~ 2.714 ~ 1 ~ 0. 013, the mean value (minimum value, maximum value) was 37.0 (13.2204.3), and the total bilirubin was increased by Z ~ (-3.711) P ~ (0.000), with a mean value (minimum value, maximum value) of 37.0 (13.2204.3). The cumulative survival rate at 3 months, 6 months and 1 year after operation was 95.55,85.9 and 78.1% respectively. Cox regression multivariate analysis showed that serum sodium (P0. 027) and total bilirubin (P0. 007) were independent risk factors for prognosis. The results of ROC and AUC analysis showed that the CI of total bilirubin was 0.3335 渭 mol / L, total bilirubin was 37 渭 mol / L (sensitivity 66.7%, specificity 94.1%). Kaplan-Merier survival rate analysis showed that the 1-year survival rate of total bilirubin 鈮，

本文編號：2108667