Identifying predictors and evaluating the role of steroids in the prevention of post-embolization syndrome after transarterial chemoembolization and bland embolization.
Identifying predictors and evaluating the role of steroids in the prevention of post-embolization syndrome after transarterial chemoembolization and bland embolization.
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DOI：
10.20524/aog.2020.0566
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发表时间：
2021
影响因子：
2.2
通讯作者：
Gandhi S
中科院分区：
文献类型：
--
作者：
Agrawal R;Majeed M;Aqeel SB;Wang Y;Haque Z;Omar YA;Upadhyay SB;Gast T;Attar BM;Gandhi S
用于治疗肝细胞癌 (HCC) 的经动脉化疗栓塞 (TACE) 和温和栓塞 (TAE) 通常会并发栓塞后综合征 (PES)。关于 TAE 后 PES 的发生率以及类固醇在 PES 中的作用的数据有限。我们报告 TACE 和 TAE 后 PES 的发生率，确定预测因子，并评估类固醇在 PES 中的作用。收集接受栓塞治疗的患者的人口统计学和临床变量并确定 PES。 PES、TACE 和 TAE 的危险因素通过逻辑回归得出。我们比较了接受地塞米松治疗的患者与未接受地塞米松治疗的患者的基线特征、PES 发生率和住院时间。共有171名患者接受了手术，平均年龄60.5岁，其中77.8%为男性，87.7%患有肝硬化。在这 171 例患者中，107 例接受了 TACE，64 例接受了 TAE。 106 名患者（61.9%）接受了地塞米松治疗，其中 85 名患者接受了 TACE，21 名患者接受了 TAE。 124 名患者 (72.5%) 出现 PES。接受 TACE 的患者中发生 PES 的人数较多，分别为 80 例（74.7%）与 44 例（68.7%），并导致住院时间延长（1.47 天与 1.12 天，P=0.034）。 PES 的预测因素包括女性（比值比 [OR] 2.76，95% 置信区间 [CI] 1.04-7.34；P=0.041）和酒精相关的 HCC（OR 3.14，95%CI 1.42-6.95；P=0.005）。地塞米松不影响住院时间（1.43 vs. 1.29 天，P=0.422）或延长住院率（18.8% vs. 15.4%，P=0.561）。 TACE 或 TAE 后 PES 的发生率没有差异，并且使用地塞米松并没有减少 PES 的发生率或住院时间。
Transarterial chemoembolization (TACE) and bland embolization (TAE), performed for hepatocellular carcinoma (HCC), are often complicated by post-embolization syndrome (PES). There are limited data regarding the incidence of PES after TAE and the role of steroids in PES. We report the incidence of PES post TACE and TAE, identify predictors, and evaluate the role of steroids in PES. Demographic and clinical variables of patients who underwent embolization were collected and PES was identified. Risk factors for PES, TACE and TAE were derived by logistic regression. We compared patients who received dexamethasone to those who did not, regarding baseline characteristics, occurrence of PES, and hospital stay. A total of 171 patients, average age 60.5 years, underwent the procedure, 77.8% were male, and 87.7% had cirrhosis. Of these 171, 107 underwent TACE and 64 TAE. Dexamethasone was given to 106 (61.9%) patients, of whom 85 had TACE and 21 TAE. One hundred twenty-four patients (72.5%) developed PES. PES occurred in more patients who underwent TACE, 80 (74.7%) vs. 44 (68.7%), and resulted in a longer hospital stay (1.47 vs. 1.12 days, P=0.034). Predictive factors for PES included female sex (odds ratio [OR] 2.76, 95% confidence interval [CI] 1.04-7.34; P=0.041), and alcohol-related HCC (OR 3.14, 95%CI 1.42-6.95; P=0.005). Dexamethasone did not affect the length of hospital stay (1.43 vs. 1.29 days, P=0.422) or the rate of prolonged hospitalization (18.8% vs. 15.4%, P=0.561). There was no difference in the incidence of PES following TACE or TAE and the use of dexamethasone did not reduce the incidence of PES or the duration of hospital stay.