Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications
Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications
复制标题
部分脾栓塞治疗肝硬化血小板减少症：血小板增加的预测因素和主要并发症的危险因素
DOI：
10.1007/s00330-015-3839-4
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发表时间：
2016-02-01
影响因子：
5.9
通讯作者：
Zhu, Kangshun
中科院分区：
文献类型：
--
作者：
Cai, Mingyue;Huang, Wensou;Zhu, Kangshun
ObjectivesTo探讨肝硬化部分脾栓塞术（PSE）后血小板增加的预测因素和主要并发症的危险因素。结果线性混合模型分析显示，脾梗死率（P <0. 001）、非梗死脾体积（P = 0. 012）和胆碱酯酶水平（P <0. 001）与PSE后血小板升高显著相关。在受试者工作特征（ROC）分析中，PSE后1年血小板计数增加≥ 60.0 × 109/L的脾梗死比率和非梗死脾体积的截止值分别为64.3%和245.8 mL。PSE后，8例患者出现严重并发症。多因素Logistic回归分析显示严重并发症与脾梗死体积（P = 0.024）和Child-Pugh评分（P = 0.018）显著相关。在ROC分析中，这两个因素的临界值为513.1 mL和复杂的区分，分别为9.5.ConclusionsPSE后血小板增值取决于脾梗死比，非梗死脾体积和胆碱酯酶水平。但脾梗死体积大和Child-Pugh评分高可能会引起并发症。要点·PSE后血小板的增加在很大程度上取决于脾梗死比例。·非梗死脾体积显著影响PSE的疗效。·高胆碱酯酶水平有助于PSE后血小板减少症的改善。·非梗死脾体积显著影响脾功能亢进的复发。并发症与脾梗死体积和Child-Pugh评分显著相关。
ObjectivesTo investigate the predictors of platelet increment and risk factors for major complications after partial splenic embolization (PSE) in cirrhosis.MethodsBetween March 2010 and June 2012, 52 cirrhotic patients with severe thrombocytopenia underwent PSE. Multiple variables were analyzed to identify the correlated factors affecting platelet increment and major complications after PSE.ResultsLinear mixed model analysis indicated the splenic infarction ratio (P< 0.001), non-infarcted splenic volume (P= 0.012), and cholinesterase level (P< 0.001) were significantly associated with the platelet increment after PSE. In receiver operating characteristic (ROC) analysis, the cut-off values of the splenic infarction ratio, and non-infarcted splenic volume for achieving an increment of ≥60.0 × 109/L in platelet counts at 1 year after PSE were 64.3 % and 245.8 mL, respectively. After PSE, eight patients developed major complications. Multivariate logistic regression analysis indicated major complications were significantly associated with the infarcted splenic volume (P= 0.024) and Child-Pugh score (P= 0.018). In ROC analysis, the cut-off values of these two factors for discriminating the uncomplicated and complicated were 513.1 mL and 9.5, respectively.ConclusionsThe platelet increment after PSE depends on the splenic infarction ratio, non-infarcted splenic volume and cholinesterase level. But a large infarcted splenic volume and a high Child-Pugh score may cause complications.Key Points•The platelet increment after PSE greatly depends on the splenic infarction ratio.•The non-infarcted splenic volume significantly affects the efficacy of PSE.•A high cholinesterase level contributes to the improvement of thrombocytopenia after PSE.•The non-infarcted splenic volume significantly affects the relapse of hypersplenism.•Complications are significantly associated with the infarcted splenic volume and Child-Pugh score.