{"title":"肝硬化相关静脉曲张出血和脾功能亢进患者接受 TIPS 和 PSE 联合治疗的最佳时机。","authors":"Jiacheng Liu, Wei Yao, Yaowei Bai, Pengfei Chen, Jiankang Qin, Songlin Song, Xiaoming Liu, Yanqiao Ren, Feng Yuan, Chuansheng Zheng, Bin Liang","doi":"10.1016/j.acra.2024.09.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Rationale and objectives: </strong>A consensus has not yet been reached regarding the optimal timing for the combination of transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE) in patients with cirrhosis-related variceal bleeding and hypersplenism. This study aimed to compare the clinical outcomes of patients who underwent either an early or late combination of TIPS and PSE.</p><p><strong>Methods: </strong>A total of 84 consecutive patients with cirrhosis-related variceal bleeding and hypersplenism who underwent TIPS and PSE between September 2016 and April 2023 were included in this retrospective multicenter study. These patients were subsequently divided into early combination (n = 36) and late combination (n = 48) groups based on the timing of the combination therapy.</p><p><strong>Results: </strong>Kaplan-Meier curves revealed a significant increase in cumulative survival in the late combination group, compared with that in the early combination group (log-rank P = 0.018). Additionally, the late combination group exhibited a lower cumulative incidence of overt hepatic encephalopathy (OHE), compared with the early combination group (log-rank P = 0.002). In Cox regression models, noninfarcted splenic volume (hazard ratio [HR] = 0.995, 95% confidence interval [CI] = 0.991-0.999, P = 0.044) and grouping (HR = 0.101, 95% CI = 0.011-0.921, P = 0.034) were identified as independent risk factors for mortality. Furthermore, the independent risk factors for OHE were serum albumin (ALB) level (P = 0.032) and grouping (P = 0.028).</p><p><strong>Conclusion: </strong>The early combination of TIPS and PSE was associated with higher risks of death and OHE than the late combination.</p>","PeriodicalId":50928,"journal":{"name":"Academic Radiology","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Optimal timing for TIPS and PSE combination treatment in patients with cirrhosis-related variceal bleeding and hypersplenism.\",\"authors\":\"Jiacheng Liu, Wei Yao, Yaowei Bai, Pengfei Chen, Jiankang Qin, Songlin Song, Xiaoming Liu, Yanqiao Ren, Feng Yuan, Chuansheng Zheng, Bin Liang\",\"doi\":\"10.1016/j.acra.2024.09.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Rationale and objectives: </strong>A consensus has not yet been reached regarding the optimal timing for the combination of transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE) in patients with cirrhosis-related variceal bleeding and hypersplenism. This study aimed to compare the clinical outcomes of patients who underwent either an early or late combination of TIPS and PSE.</p><p><strong>Methods: </strong>A total of 84 consecutive patients with cirrhosis-related variceal bleeding and hypersplenism who underwent TIPS and PSE between September 2016 and April 2023 were included in this retrospective multicenter study. These patients were subsequently divided into early combination (n = 36) and late combination (n = 48) groups based on the timing of the combination therapy.</p><p><strong>Results: </strong>Kaplan-Meier curves revealed a significant increase in cumulative survival in the late combination group, compared with that in the early combination group (log-rank P = 0.018). Additionally, the late combination group exhibited a lower cumulative incidence of overt hepatic encephalopathy (OHE), compared with the early combination group (log-rank P = 0.002). In Cox regression models, noninfarcted splenic volume (hazard ratio [HR] = 0.995, 95% confidence interval [CI] = 0.991-0.999, P = 0.044) and grouping (HR = 0.101, 95% CI = 0.011-0.921, P = 0.034) were identified as independent risk factors for mortality. Furthermore, the independent risk factors for OHE were serum albumin (ALB) level (P = 0.032) and grouping (P = 0.028).</p><p><strong>Conclusion: </strong>The early combination of TIPS and PSE was associated with higher risks of death and OHE than the late combination.</p>\",\"PeriodicalId\":50928,\"journal\":{\"name\":\"Academic Radiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-10-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Academic Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.acra.2024.09.003\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acra.2024.09.003","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
理由和目标：关于肝硬化相关静脉曲张出血和脾功能亢进患者联合使用经颈静脉肝内门体分流术（TIPS）和部分脾栓塞术（PSE）的最佳时机，目前尚未达成共识。本研究旨在比较早期或晚期接受 TIPS 和 PSE 联合治疗的患者的临床疗效：这项回顾性多中心研究共纳入了2016年9月至2023年4月期间接受TIPS和PSE治疗的84例连续性肝硬化相关静脉曲张出血和脾功能亢进患者。随后，根据联合治疗的时间将这些患者分为早期联合组（36 人）和晚期联合组（48 人）：Kaplan-Meier曲线显示，与早期联合治疗组相比，晚期联合治疗组的累积生存期显著延长（log-rank P = 0.018）。此外，与早期联合治疗组相比，晚期联合治疗组的显性肝性脑病（OHE）累积发生率较低（log-rank P = 0.002）。在 Cox 回归模型中，非梗死脾脏体积（危险比 [HR] = 0.995，95% 置信区间 [CI] = 0.991-0.999，P = 0.044）和分组（HR = 0.101，95% CI = 0.011-0.921，P = 0.034）被确定为死亡率的独立危险因素。此外，血清白蛋白（ALB）水平（P = 0.032）和分组（P = 0.028）也是OHE的独立危险因素：结论：TIPS和PSE的早期组合比晚期组合具有更高的死亡和OHE风险。
Optimal timing for TIPS and PSE combination treatment in patients with cirrhosis-related variceal bleeding and hypersplenism.
Rationale and objectives: A consensus has not yet been reached regarding the optimal timing for the combination of transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE) in patients with cirrhosis-related variceal bleeding and hypersplenism. This study aimed to compare the clinical outcomes of patients who underwent either an early or late combination of TIPS and PSE.
Methods: A total of 84 consecutive patients with cirrhosis-related variceal bleeding and hypersplenism who underwent TIPS and PSE between September 2016 and April 2023 were included in this retrospective multicenter study. These patients were subsequently divided into early combination (n = 36) and late combination (n = 48) groups based on the timing of the combination therapy.
Results: Kaplan-Meier curves revealed a significant increase in cumulative survival in the late combination group, compared with that in the early combination group (log-rank P = 0.018). Additionally, the late combination group exhibited a lower cumulative incidence of overt hepatic encephalopathy (OHE), compared with the early combination group (log-rank P = 0.002). In Cox regression models, noninfarcted splenic volume (hazard ratio [HR] = 0.995, 95% confidence interval [CI] = 0.991-0.999, P = 0.044) and grouping (HR = 0.101, 95% CI = 0.011-0.921, P = 0.034) were identified as independent risk factors for mortality. Furthermore, the independent risk factors for OHE were serum albumin (ALB) level (P = 0.032) and grouping (P = 0.028).
Conclusion: The early combination of TIPS and PSE was associated with higher risks of death and OHE than the late combination.
期刊介绍：
Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.
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