在患有急性水出血和严重酒精相关肝炎的高风险患者中,应考虑预防性TIPS
Marika Rudler1,2,3, Virginia Hernandez Gea4, Hélène Larrue5
1AP-HP, Sorbonne Université, Liver Intensive Care Unit, Hepatogastroenterology Department, La Pitié-Salpêtrière Hospital, Paris, France.
JHEP reports : innovation in hepatology
|December 9, 2025
概括
预防性横性肝内移植系统分流 (pTIPS) 可能改善严重酒精相关性肝炎和急性水出血的患者的治疗结果. 与标准护理相比,这种治疗减少了复出血和,这表明pTIPS没有禁忌.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 干预性放射学 干预性放射学
- 胃肠病学 胃肠病学
背景情况:
- 严重的与酒精有关的肝炎 (AH) 和急性水出血 (AVB) 可以同时发生.
- 在患有这两种疾病的高风险患者中,预防性横性肝内移植系统分流 (pTIPS) 的有效性尚不清楚.
研究的目的:
- 在高风险的AVB患者中,以pTIPS治疗的严重AH的结果与内镜和药物治疗 (Endo+药物) 的结果进行比较.
主要方法:
- 从四个队伍中对142名AVB患者进行了回顾性分析.
- 纳入标准:AVB,高风险 (Child-Pugh B有活跃出血或C10-13肝硬化),并怀疑严重的AH.
- 主要终点:42天死亡率;次要终点:6个月后再出血,,肝脏脑病.
主要成果:
- 在pTIPS组 (n=47) 显示了16%的42天死亡率,而在Endo+药物组 (n=95) (p=0.2) 中为30%.
- 在pTIPS组中显著降低复出出血 (2.8%与24%,p=0.026) 和炎 (6%与52%,p<0.001).
- 肝脏脑病发病率在各组之间是相似的 (p=0.2).
结论:
- 在患有高风险AVB的严重AH患者中,pTIPS与更好的结果有关.
- 当用于AVB管理时,严重的AH不应该是pTIPS的禁忌.
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