经颈静脉肝内门体静脉分流术治疗乙型肝炎肝硬化门脉高压症患者疗效和血流动力学变化分析

doi:10.3969/j.issn.1672-5069.2021.03.024

摘要/Abstract

摘要： 目的探讨采用经颈静脉肝内门体静脉分流术(TIPS)治疗乙型肝炎肝硬化并发门脉高压症(PHT)患者的疗效及其对血流动力学的影响。方法 2017年1月～2019年5月我院诊治的乙型肝炎肝硬化并发PHT患者96例,被随机分为两组,分组接受TIPS或腹腔镜下脾切除联合门奇静脉断流术治疗。采用ELISA法检测血清缺氧诱导因子-1α(HlF-1α)、金属基质蛋白酶2(MMP-2)和血管内皮生长因子(VEGF),使用彩色多普勒超声诊断系统检测门静脉直径(PVD)、门静脉血流流量(PVF)和门静脉血流流速(PVV)。结果治疗后,TIPS组血清白蛋白水平为(36.3±3.6)g/L,血氨水平为(92.1±4.5) μmmol/L,显著高于开腹手术组【分别为(32.6±3.1)g/L和(54.2±5.6)μmmol/L, P<0.05】;PVV为(36.4±3.8)cm/s),显著快于开腹组【(32.5±3.1)cm/s),P<0.05】;血清HIF-α水平为(0.5±0.3)ng/mL,显著高于开腹组【(0.4±0.1)ng/mL,P<0.05】,而血清MMP-2和VEGF水平分别为(213.6±30.4)ng/mL和(92.3±9.7)ng/mL,显著低于开腹组【分别为(244.9±35.3)ng/mL和(112.4±12.8)ng/mL,P<0.05】;在术后6个月,TIPS组肝性脑病发生率为22.9%,显著高于开腹组的8.3%(P<0.05),而两组感染、再出血和肝功能稳定发生率无显著差异(P>0.05)。结论采用TIPS术治疗乙型肝炎肝硬化并发PHT患者可改善门脉血流动力学参数,防止再出血,但有导致血氨升高和发生肝性脑病之虞,应该注意防治。

关键词: 肝硬化, 门脉高压症, 经颈静脉肝内门体静脉分流术, 缺氧诱导因子-1α, 金属蛋白酶2, 血流动力学, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy and changes of portal hemodynamics in patients with hepatitis B cirrhosis complicated by portal hypertension (PHT) after transjugular intrahepatic portosystemic stent-shunt (TIPS).Methods A total of 96 patients with cirrhosis and PHT were recruited in our hospital between January 2017 and May 2019, and were divided randomly into two groups, underwent TIPS or laparoscopic splenectomy and esophagogastric devascularization (LSED). Serum hypoxia-inducible factor-1α (HlF-1α), matrix metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) were detected by ELISA, and portal vein diameter (PVD), portal vein flow (PVF) and portal vein velocity (PVV)] were determined by sonography.Results After treatment, serum albumin and blood ammonia levels in patients receiving TIPS were (36.3±3.6)g/L and (92.1±4.5) μmmol/L, both significantly higher than [(32.6±3.1)g/L and (54.2±5.6)μmmol/L, respectively, P<0.05] in LSED-treated thePVV was (36.4±3.8)cm/s), significantly quicker than [(32.5±3.1)cm/s), patients; P<0.05] in LSED-treated patients; serum HIF-α level was (0.5±0.3)ng/mL, significantly higher than [(0.4±0.1)ng/mL, P<0.05], whil e serum MMP-2 and VEGF levels were (213.6±30.4)ng/mL and (92.3±9.7)ng/mL, significantly lower than [(244.9±35.3)ng/mL and (112.4±12.8)ng/mL, respectively, P<0.05] in LSED-treated patients; six months after treatment, the incidence of hepatic encephalopathy (HE) in TIPS-treated patients was 22.9%, significantly higher than 8.3% inLSED-treated patients(P<0.05), and there were no significant differences as respect to the incidences of infection, re-bleeding and stable liver function tests in the two groups (P>0.05).Conclusion The application of TIPS could improve the hemodynamics parameters and reduce the risk of gastrointestinal bleeding in patients with hepatitis B liver cirrhosis, with the disadvantage of increased blood ammonia and HE occurrence, which might be taken into consideration when making the therapeutic strategy.

Key words: Liver cirrhosis, Portal hypertension, Transjugular intrahepatic portosystemic stent-shunt, Hypoxia-inducible factor-1α, Matrix metalloproteinase-2, Portal hemodynamics, Therapy

王云强, 王丽萍, 黄冬梅, 王艳彬, 刘晓杰, 李明宇, 赵欣宇. 经颈静脉肝内门体静脉分流术治疗乙型肝炎肝硬化门脉高压症患者疗效和血流动力学变化分析[J]. 实用肝脏病杂志, 2021, 24(3): 399-402.

Wang Yunqiang, Wang Liping, Huang Dongmei, et al. Changes ofportal hemodynamics in patients with hepatitis B cirrhosis after transjugular intrahepatic portosystemic stent-shunt[J]. Journal of Practical Hepatology, 2021, 24(3): 399-402.

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