关键词: 肝硬化失代偿, 肝硬化再代偿, 早期经颈静脉肝内门体分流术, 预测因素分析

Abstract: To study the occurrence rate of recompensation after transjugular intrahepatic portosystemic shunt (TIPS) treatment in patients with decompensated cirrhosis and analyze related predictive factors, based on the criteria of cirrhosis recompensation in the Baveno Ⅶ consensus. Methods    A retrospective analysis was performed on 89 cirrhotic patients with portal hypertension who underwent TIPS at Renji Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, for esophagogastric variceal hemorrhage or refractory ascites. Clinical data, intraoperative findings, measurement results, laboratory tests, imaging studies, and 12-month follow-up information were reviewed. Univariate and multivariate Logistic models were used to analyze the predictive factors for the occurrence of recompensation and relevant subgroup analysis was performed. Results    46 of 89 patients received early TIPS treatment within 72 hours of onset. After TIPS, 42.7% of patients developed “re-compensation” of liver cirrhosis. MELD score <19 and early TIPS are independent predictive factors for the occurrence of “re-compensation” of liver cirrhosis after TIPS. The early TIPS group had significantly better rates of liver cirrhosis “re-compensation” (62.5% vs. 23.8%, P<0.05), hepatic encephalopathy (10.0% vs. 23.8%, P<0.05), spleen volume reduction ratio ［(27.5±10.2)% vs. (10.9±5.5)%, P<0.01］, and liver stiffness value reduction ratio ［(4.5±1.2)% vs. (1.9±0.75)%, P<0.01］ compared to the non-early TIPS group. Conclusion    MELD score <19, early TIPS is a predictive factor for “re-compensation” of liver cirrhosis in post-TIPS liver cirrhosis patients. Early TIPS can reduce the incidence of postoperative hepatic encephalopathy, increase the occurrence of “re-compensation” of cirrhosis, promote spleen shrinkage better, and improve liver elasticity.

Key words: decompensated cirrhosis, compensated cirrhosis, early TIPS, predictive factor analysis