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

Abstract

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

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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Changes ofportal hemodynamics in patients with hepatitis B cirrhosis after transjugular intrahepatic portosystemic stent-shunt

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