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腹水是失代偿期肝硬化的常见并发症,10年内发生率可高达60%[1],每年约10%的病人可进展为顽固性腹水,病人的生存率和生存质量均较低[2]。已有文献[3-4]报道经颈静脉肝内门体分流术(TIPS)可通过降低门脉压力作为治疗肝硬化失代偿期顽固性腹水的有效手段。肝窦阻塞综合征(hepatic sinusoidal obstruction syndrome,HSOS)或肝小静脉闭塞病(hepatic veno-occlusive disease,HVOD),是一种多种病因导致的以腺泡Ⅲ区肝窦内皮细胞肿胀、坏死、脱落,导致肝血窦堵塞和受压狭窄为主要病理特征的一种血管性肝病,急性窦性门静脉高压是其突出临床特征[5]。虽然抗凝-TIPS阶梯治疗是相关共识推荐的治疗策略,但关于TIPS治疗含吡咯里西啶植物诱发的HSOS(PA-HSOS)所致顽固性腹水病人疗效尚存疑[6-7],本研究回顾性收集了行TIPS术治疗的PA-HSOS和失代偿期肝硬化两类病因顽固性腹水的临床资料,并对TIPS治疗的疗效进行分析。现作报道。
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本研究共纳入183例行TIPS术治疗顽固性腹水的PA-HSOS和失代偿期肝硬化病人。其中,PA-HSOS病人141例,失代偿期肝硬化病人42例。失代偿期肝硬化组病因包括乙型病毒性肝硬化20例、酒精性肝硬化9例、原发性胆汁性肝硬化2例、自身免疫性肝硬化2例、血吸虫性肝硬化4例、丙型肝炎性肝硬化2例、乙型合并丙型肝炎性肝硬化2例、隐源性肝硬化1例。PA-HSOS病人在年龄、Child-Pugh分级、MELD评分、TIPS术后门静脉压力降低幅度方面均高于失代偿期肝硬化病人(P < 0.05~P < 0.01),门静脉血流速度低于失代偿期肝硬化病人(P < 0.01)(见表 1)。
变量 PA-HSOS组(n=141) 失代偿期肝硬化组(n=42) χ2 P 男[n; 构成比(%)] 92(65.25) 25(59.52) 0.46 >0.05 年龄(x±s)/岁 63.74±9.66 58.62±11.68 5.94* < 0.05 Child-Pugh分级[n; 构成比(%)] A(5~6分) 3.00(2.13) 8.00(19.05) B(7~9分) 74.00(52.48) 33.00(78.57) 5.81△ < 0.01 C(10~13分) 64.00(45.39) 1.00(2.38) MELD评分(x±s)/分 14.25±6.62 11.05±3.82 9.29* < 0.01 腹水严重度分级[n; 构成比(%)] 中度重度 49.00(34.75) 92.00(65.25) 23.00(54.76) 19.00(45.24) 5.43 < 0.05 凝血酶原时间/s 16.00(14.00~18.40) 14.00(12.90~16.00) 3.79△ < 0.01 国际标准化比值 1.39(1.20~1.60) 1.23(1.11~1.40) 3.43△ < 0.01 丙氨酸氨基转移酶/(U/L) 43.30(22.20~92.90) 18.75(13.80~26.50) 5.16△ < 0.01 天门冬氨酸氨基转移酶/(U/L) 61.10(36.20~113.80) 28.10(22.00~41.70) 6.07△ < 0.01 总胆红素/(μmol/L) 46.60(32.30~68.50) 19.50(12.70~31.40) 6.88△ < 0.01 白蛋白/(g/L) 32.80(30.70~35.20) 31.50(29.50~36.20) 1.12△ >0.05 肌酐/(mg/dL) 76.00(61.00~102.00) 64.00(52.00~102.00) 1.52△ >0.05 白细胞/(×109/L) 6.50(5.00~8.20) 3.40(2.50~5.30) 5.71△ < 0.01 血小板/(×109/L) 94.00(71.00~126.00) 65.50(39.00~153.00) 2.55△ < 0.05 术前肝性脑病[n; 构成比(%)] 8.00(5.67) 2.00(4.76) 0.05 >0.05 术前门静脉系统血栓[n; 构成比(%)] 19.00(13.48) 15.00(35.71) 10.58 < 0.01 门静脉血流速度(x±s)/ (cm/s) 14.56±6.09 18.49±8.05 2.61* < 0.01 术前门静脉压力(x±s)/mmHg 29.22±4.77 27.80±4.74 0.11* >0.05 术后门静脉压力(x±s)/mmHg 17.45±5.02 18.87±5.63 0.72* >0.05 门静脉压力梯度下降值(x±s) /mmHg 12.95±7.28 9.90±5.61 6.17* < 0.01 *示t值; △示Z值 表 1 行TIPS术治疗前2组病人基线资料的比较
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本研究中,PA-HSOS病人中位随访时间为16.63(10.67~26.60)个月,失代偿期肝硬化病人中位随访时间为16.47(9.40~41.53)个月。在随访期间,PA-HSOS病人共死亡18例,7例主要死因为肝功能衰竭,3例主要死因为感染,1例主要死因为肝性脑病,6例主要死因为多器官功能衰竭,1例主要死因与肝脏疾病无关。失代偿期肝硬化病人共死亡10例,5例主要死因为肝功能衰竭,1例主要死因为感染,1例主要死因为肝性脑病,2例主要死因为多器官功能衰竭,1例主要死因与肝脏疾病无关。在单因素分析中,影响PA-HSOS病人预后的因素包括MELD评分、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、肌酐、门静脉血流速度及术前门静脉压力(P < 0.05~P < 0.01)(见表 2)。多因素分析示MELD评分、天门冬氨酸氨基转移酶、总胆红素、肌酐、门静脉血流速度是影响预后的独立危险因素(P < 0.05~P < 0.01)(见表 3)。失代偿期肝硬化病人中,单因素分析示术前、后门静脉压力与病人的预后密切相关(P < 0.05)(见表 4),多因素分析示未发现独立危险因素(P>0.05)(见表 5)。
风险因素 B SE Waldχ2 P OR 95%CI 性别(男,%) -0.656 0.567 1.34 >0.05 0.519 0.171~1.577 年龄/岁 0.043 0.030 2.05 >0.05 1.044 0.984~1.107 终末期肝病模型评分/分 0.103 0.026 15.22 < 0.01 1.109 1.053~1.168 Child-Pugh C级(相比于A级、B级) 1.191 0.527 2.11 >0.05 3.289 0.072~9.235 腹水重度相比于中度 0.672 0.569 1.39 >0.05 1.958 0.642~5.972 凝血酶原时间/s 0.024 0.018 1.71 >0.05 1.024 0.988~1.062 国际标准化比值 0.102 0.132 0.60 >0.05 1.107 0.855~1.433 丙氨酸氨基转移酶/(U/L) 0.003 0.001 11.22 < 0.01 1.003 1.001~1.004 天门冬氨酸氨基转移酶/(U/L) 0.004 0.001 25.81 < 0.01 1.004 1.002~1.005 总胆红素/(μmol/L) 0.008 0.002 11.84 < 0.01 1.009 1.004~1.013 白蛋白/(g/L) -0.106 0.068 2.40 >0.05 0.900 0.787~1.029 肌酐/(mg/dL) 0.006 0.002 5.16 < 0.05 1.006 1.001~1.010 白细胞/(×109/L) 0.007 0.032 0.05 >0.05 1.007 0.947~1.072 血小板/(×109/L) -0.012 0.007 2.98 >0.05 0.988 0.974~1.002 术前肝性脑病 0.906 0.753 1.45 >0.05 2.475 0.566~10.827 术前门静脉系统血栓 -1.010 1.029 0.96 >0.05 0.364 0.048~2.738 门静脉血流速度/ (cm/s) 0.079 0.033 5.61 < 0.05 1.082 1.014~1.155 术前门静脉压力/mmHg 0.085 0.048 3.18 >0.05 1.089 0.992~1.196 术后门静脉压力/mmHg 0.074 0.045 2.68 >0.05 1.077 0.986~1.176 门静脉压力梯度下降值/mmHg -0.037 0.033 1.23 >0.05 0.964 0.904~1.028 注:因Child-Pugh A级病人无死亡,故将A级、B级病人全为一类进行分析 表 2 行TIPS术治疗PA-HSOS病人顽固性腹水后生存时间的单因素危险因素分析
风险因素 B SE Waldχ2 P OR 95%CI 终末期肝病模型评分/分 0.072 0.047 2.36 < 0.05 2.362 0.980~1.179 丙氨酸氨基转移酶/(U/L) -0.001 0.002 0.23 >0.05 0.999 0.994~1.003 天门冬氨酸氨基转移酶/(U/L) 0.005 0.002 5.73 < 0.05 1.005 1.001~1.009 总胆红素/(μmol/L) 0.007 0.004 4.11 < 0.05 1.007 1.000~1.014 肌酐/(mg/dL) -0.011 0.005 5.04 < 0.05 0.989 0.980~0.999 门静脉血流速度/(cm/s) 0.100 0.036 7.97 < 0.01 1.105 1.031~1.185 术前门静脉压力/mmHg 0.065 0.051 1.59 >0.05 1.067 0.965~1.180 表 3 行TIPS术治疗PA-HSOS病人顽固性腹水后生存时间的多因素危险因素分析
风险因素 B SE Waldχ2 P OR 95%CI 性别(男,%) -0.164 0.650 0.06 >0.05 0.849 0.238~3.031 年龄/岁 -0.009 0.027 0.11 >0.05 0.991 0.939~1.046 终末期肝病模型评分/分 0.102 0.068 2.26 >0.05 1.107 0.970~1.264 Child-Pugh B级(相比于A级) 0.920 1.069 0.74 >0.05 2.510 0.309~20.391 Child-Pugh C级(相比于A级) 1.649 1.446 1.30 >0.05 5.203 0.306~88.449 腹水重度相比于中度 0.668 0.649 1.06 >0.05 1.951 0.547~6.965 凝血酶原时间/s -0.019 0.152 0.02 >0.05 0.981 0.728~1.322 国际标准化比值 0.422 1.600 0.07 >0.05 1.525 0.066~35.068 丙氨酸氨基转移酶/(U/L) -0.038 0.030 1.67 >0.05 0.962 0.908~1.020 天门冬氨酸氨基转移酶/(U/L) -0.028 0.024 1.33 >0.05 0.972 0.927~1.020 总胆红素/(μmol/L) 0.003 0.024 0.02 >0.05 1.003 0.957~1.052 白蛋白/(g/L) -0.112 0.077 2.11 >0.05 0.894 0.769~1.040 肌酐/(mg/dL) 0.005 0.003 3.45 >0.05 1.005 1.000~1.010 白细胞/(×109/L) -0.162 0.161 1.01 >0.05 0.850 0.620~1.167 血小板/(×109/L) -0.006 0.005 1.44 >0.05 0.994 0.983~1.004 术前肝性脑病 -3.089 6.450 0.23 >0.05 0.046 0.000~14 082.967 术前门静脉系统血栓 -1.758 1.054 2.78 >0.05 0.172 0.022~1.362 门静脉血流速度/(cm/s) 0.054 0.044 1.54 >0.05 1.056 0.969~1.150 术前门静脉压力/mmHg 0.181 0.075 5.73 < 0.05 1.198 1.033~1.389 术后门静脉压力/mmHg 0.208 0.083 6.29 < 0.05 1.231 1.046~1.449 门静脉压力梯度下降值/mmHg -0.008 0.063 0.02 >0.05 0.992 0.876~1.123 表 4 行TIPS术治疗失代偿期肝硬化病人顽固性腹水后生存时间的单因素危险因素分析
风险因素 B SE Waldχ2 P OR 95%CI 术前门静脉压力/mmHg 0.090 0.099 0.83 >0.05 1.094 0.902~1.328 术后门静脉压力/mmHg 0.154 0.098 2.47 >0.05 1.167 0.963~1.415 表 5 行TIPS术治疗失代偿期肝硬化病人顽固性腹水后生存时间的多因素危险因素分析
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倾向性评分匹配(PSM)前,PA-HSOS病人中位生存时间16.63 (10.67~26.60)个月,随访期间有18例死亡,术后3个月、6个月、1年、2年生存率分别为97.9%、95.7%、91.5%、87.9%;失代偿期肝硬化病人共10例死亡,中位生存时间为16.47(9.40~41.53)个月,术后3个月、6个月、1年、2年生存率分别为92.9%、85.7%、83.3%、77.6%;2组病人术后生存差异无统计学意义(χ2=1.74,P>0.05)(见图 1)。将卡钳值设定为0.2,按照1∶ 1进行倾向性评分匹配后,24例PA-HSOS和24例失代偿期肝硬化病人成功匹配,2组病人匹配因素均衡可比,PA-HSOS病人术后2年生存率为100%,失代偿期肝硬化病人术后3个月、6个月、1年、2年生存率为87.5%、83.3%、73.5%、36.8%,PA-HSOS病人的术后生存时间显著长于失代偿期肝硬化病人[15.17 (10.27~27.03)个月]vs 13.75(10.67~21.07)个月(χ2=6.59,P < 0.01)(见图 2)。
经颈静脉肝内门体分流术治疗PA-HSOS和失代偿期肝硬化相关顽固性腹水的生存预后分析
Analysis of survival prognosis of the transjugular intrahepatic portosystemic shunt in the treatment of PA-HSOS and decompensated cirrhose-related refractory ascites
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摘要:
目的比较含吡咯里西啶植物诱发的肝窦阻塞综合征(PA-HSOS)和失代偿期肝硬化合并顽固性腹水行经颈静脉肝内门体分流术(TIPS)治疗病人的生存预后。 方法回顾性分析141例PA-HSOS和42例失代偿期肝硬化并发顽固性腹水采用TIPS治疗的病人的临床资料,采用Kaplan-Meier分析计算2组病人TIPS术后生存率,并采用log-rank检验进行比较。并采用倾向性评分匹配(PSM),卡钳值设置为0.2,以1∶1匹配年龄、终末期肝病模型(MELD)评分、术前显性肝性脑病、术前门静脉系统血栓、门静脉血流速度。 结果所有病人的中位随访时间为16.57个月。PA-HSOS病人的术前Child-Pugh分级和MELD评分均高于失代偿期肝硬化病人(P < 0.01),2组病人TIPS术后生存时间差异无统计学意义[16.63(10.67~26.60)个月vs 16.47(9.40~41.53)个月](P>0.05)。进行倾向性评分匹配后,24例PA-HSOS和24例失代偿期肝硬化病人成功匹配,PA-HSOS病人的术后生存时间长于失代偿期肝硬化病人[15.17(10.27~27.03)个月vs 13.75(10.67~21.07)个月](P < 0.01)。 结论TIPS治疗PA-HSOS或失代偿期肝硬化相关顽固性腹水,尽管前者术前肝功能和门静脉血流动力学更差,但PA-HSOS病人术后生存不劣于失代偿期肝硬化病人。 Abstract:ObjectiveTo compare the survival prognosis of the transjugular intrahepatic portosystemic shunt(TIPS) in the treatment of pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome(PA-HSOS) and decompensated cirrhose-related refractory ascites. MethodsThe clinical data of 141 patients with PA-HSOS and 42 patients with decompensated cirrhose-related refractory ascites were retrospective analyzed.The survival rates in two groups after TIPS were calculated using the Kaplan-Meier analysis, and the results of which was compared using log-rank test.The propensity score matching(PSM) was used, the caliper value was set to 0.2.The age, end-stage model of liver disease(MELD) score, preoperative dominant hepatic encephalopathy, preoperative portal venous thrombosis and portal venous blood flow velocity were matched by 1:1. ResultsThe median survival time in all cases was 16.57 months.The preoperative Child-Pugh grade and MELD score in PA-HSOS patients were higher than those in decompensated cirrhosis patients(P < 0.01).There was no statistical significance in the survival time after TIPS between two groups[16.63 (10.67-26.60) months vs 16.47 (9.40-41.53) months] (P>0.05).After propensity score matching, 24 cases with PA-HSOS were successfully matched with 24 cases with decompensated cirrhosis.The survival time of PA-HSOS patients was longer than that of decompensated cirrhosis patients[15.17(10.27-27.03) months vs 13.75(10.67-21.07) months] (P < 0.01). ConclusionsThe TIPS can treat the PA-HSOS or decompensated cirrhose-related refractory ascites.Although the former has poorer preoperative liver function and portal hemodynamics, the PA-HSOS patients do not have worse postoperative survival compared with the decompensated cirrhose-related refractory ascites patients. -
表 1 行TIPS术治疗前2组病人基线资料的比较
变量 PA-HSOS组(n=141) 失代偿期肝硬化组(n=42) χ2 P 男[n; 构成比(%)] 92(65.25) 25(59.52) 0.46 >0.05 年龄(x±s)/岁 63.74±9.66 58.62±11.68 5.94* < 0.05 Child-Pugh分级[n; 构成比(%)] A(5~6分) 3.00(2.13) 8.00(19.05) B(7~9分) 74.00(52.48) 33.00(78.57) 5.81△ < 0.01 C(10~13分) 64.00(45.39) 1.00(2.38) MELD评分(x±s)/分 14.25±6.62 11.05±3.82 9.29* < 0.01 腹水严重度分级[n; 构成比(%)] 中度重度 49.00(34.75) 92.00(65.25) 23.00(54.76) 19.00(45.24) 5.43 < 0.05 凝血酶原时间/s 16.00(14.00~18.40) 14.00(12.90~16.00) 3.79△ < 0.01 国际标准化比值 1.39(1.20~1.60) 1.23(1.11~1.40) 3.43△ < 0.01 丙氨酸氨基转移酶/(U/L) 43.30(22.20~92.90) 18.75(13.80~26.50) 5.16△ < 0.01 天门冬氨酸氨基转移酶/(U/L) 61.10(36.20~113.80) 28.10(22.00~41.70) 6.07△ < 0.01 总胆红素/(μmol/L) 46.60(32.30~68.50) 19.50(12.70~31.40) 6.88△ < 0.01 白蛋白/(g/L) 32.80(30.70~35.20) 31.50(29.50~36.20) 1.12△ >0.05 肌酐/(mg/dL) 76.00(61.00~102.00) 64.00(52.00~102.00) 1.52△ >0.05 白细胞/(×109/L) 6.50(5.00~8.20) 3.40(2.50~5.30) 5.71△ < 0.01 血小板/(×109/L) 94.00(71.00~126.00) 65.50(39.00~153.00) 2.55△ < 0.05 术前肝性脑病[n; 构成比(%)] 8.00(5.67) 2.00(4.76) 0.05 >0.05 术前门静脉系统血栓[n; 构成比(%)] 19.00(13.48) 15.00(35.71) 10.58 < 0.01 门静脉血流速度(x±s)/ (cm/s) 14.56±6.09 18.49±8.05 2.61* < 0.01 术前门静脉压力(x±s)/mmHg 29.22±4.77 27.80±4.74 0.11* >0.05 术后门静脉压力(x±s)/mmHg 17.45±5.02 18.87±5.63 0.72* >0.05 门静脉压力梯度下降值(x±s) /mmHg 12.95±7.28 9.90±5.61 6.17* < 0.01 *示t值; △示Z值 表 2 行TIPS术治疗PA-HSOS病人顽固性腹水后生存时间的单因素危险因素分析
风险因素 B SE Waldχ2 P OR 95%CI 性别(男,%) -0.656 0.567 1.34 >0.05 0.519 0.171~1.577 年龄/岁 0.043 0.030 2.05 >0.05 1.044 0.984~1.107 终末期肝病模型评分/分 0.103 0.026 15.22 < 0.01 1.109 1.053~1.168 Child-Pugh C级(相比于A级、B级) 1.191 0.527 2.11 >0.05 3.289 0.072~9.235 腹水重度相比于中度 0.672 0.569 1.39 >0.05 1.958 0.642~5.972 凝血酶原时间/s 0.024 0.018 1.71 >0.05 1.024 0.988~1.062 国际标准化比值 0.102 0.132 0.60 >0.05 1.107 0.855~1.433 丙氨酸氨基转移酶/(U/L) 0.003 0.001 11.22 < 0.01 1.003 1.001~1.004 天门冬氨酸氨基转移酶/(U/L) 0.004 0.001 25.81 < 0.01 1.004 1.002~1.005 总胆红素/(μmol/L) 0.008 0.002 11.84 < 0.01 1.009 1.004~1.013 白蛋白/(g/L) -0.106 0.068 2.40 >0.05 0.900 0.787~1.029 肌酐/(mg/dL) 0.006 0.002 5.16 < 0.05 1.006 1.001~1.010 白细胞/(×109/L) 0.007 0.032 0.05 >0.05 1.007 0.947~1.072 血小板/(×109/L) -0.012 0.007 2.98 >0.05 0.988 0.974~1.002 术前肝性脑病 0.906 0.753 1.45 >0.05 2.475 0.566~10.827 术前门静脉系统血栓 -1.010 1.029 0.96 >0.05 0.364 0.048~2.738 门静脉血流速度/ (cm/s) 0.079 0.033 5.61 < 0.05 1.082 1.014~1.155 术前门静脉压力/mmHg 0.085 0.048 3.18 >0.05 1.089 0.992~1.196 术后门静脉压力/mmHg 0.074 0.045 2.68 >0.05 1.077 0.986~1.176 门静脉压力梯度下降值/mmHg -0.037 0.033 1.23 >0.05 0.964 0.904~1.028 注:因Child-Pugh A级病人无死亡,故将A级、B级病人全为一类进行分析 表 3 行TIPS术治疗PA-HSOS病人顽固性腹水后生存时间的多因素危险因素分析
风险因素 B SE Waldχ2 P OR 95%CI 终末期肝病模型评分/分 0.072 0.047 2.36 < 0.05 2.362 0.980~1.179 丙氨酸氨基转移酶/(U/L) -0.001 0.002 0.23 >0.05 0.999 0.994~1.003 天门冬氨酸氨基转移酶/(U/L) 0.005 0.002 5.73 < 0.05 1.005 1.001~1.009 总胆红素/(μmol/L) 0.007 0.004 4.11 < 0.05 1.007 1.000~1.014 肌酐/(mg/dL) -0.011 0.005 5.04 < 0.05 0.989 0.980~0.999 门静脉血流速度/(cm/s) 0.100 0.036 7.97 < 0.01 1.105 1.031~1.185 术前门静脉压力/mmHg 0.065 0.051 1.59 >0.05 1.067 0.965~1.180 表 4 行TIPS术治疗失代偿期肝硬化病人顽固性腹水后生存时间的单因素危险因素分析
风险因素 B SE Waldχ2 P OR 95%CI 性别(男,%) -0.164 0.650 0.06 >0.05 0.849 0.238~3.031 年龄/岁 -0.009 0.027 0.11 >0.05 0.991 0.939~1.046 终末期肝病模型评分/分 0.102 0.068 2.26 >0.05 1.107 0.970~1.264 Child-Pugh B级(相比于A级) 0.920 1.069 0.74 >0.05 2.510 0.309~20.391 Child-Pugh C级(相比于A级) 1.649 1.446 1.30 >0.05 5.203 0.306~88.449 腹水重度相比于中度 0.668 0.649 1.06 >0.05 1.951 0.547~6.965 凝血酶原时间/s -0.019 0.152 0.02 >0.05 0.981 0.728~1.322 国际标准化比值 0.422 1.600 0.07 >0.05 1.525 0.066~35.068 丙氨酸氨基转移酶/(U/L) -0.038 0.030 1.67 >0.05 0.962 0.908~1.020 天门冬氨酸氨基转移酶/(U/L) -0.028 0.024 1.33 >0.05 0.972 0.927~1.020 总胆红素/(μmol/L) 0.003 0.024 0.02 >0.05 1.003 0.957~1.052 白蛋白/(g/L) -0.112 0.077 2.11 >0.05 0.894 0.769~1.040 肌酐/(mg/dL) 0.005 0.003 3.45 >0.05 1.005 1.000~1.010 白细胞/(×109/L) -0.162 0.161 1.01 >0.05 0.850 0.620~1.167 血小板/(×109/L) -0.006 0.005 1.44 >0.05 0.994 0.983~1.004 术前肝性脑病 -3.089 6.450 0.23 >0.05 0.046 0.000~14 082.967 术前门静脉系统血栓 -1.758 1.054 2.78 >0.05 0.172 0.022~1.362 门静脉血流速度/(cm/s) 0.054 0.044 1.54 >0.05 1.056 0.969~1.150 术前门静脉压力/mmHg 0.181 0.075 5.73 < 0.05 1.198 1.033~1.389 术后门静脉压力/mmHg 0.208 0.083 6.29 < 0.05 1.231 1.046~1.449 门静脉压力梯度下降值/mmHg -0.008 0.063 0.02 >0.05 0.992 0.876~1.123 表 5 行TIPS术治疗失代偿期肝硬化病人顽固性腹水后生存时间的多因素危险因素分析
风险因素 B SE Waldχ2 P OR 95%CI 术前门静脉压力/mmHg 0.090 0.099 0.83 >0.05 1.094 0.902~1.328 术后门静脉压力/mmHg 0.154 0.098 2.47 >0.05 1.167 0.963~1.415 -
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