Relevance of Spontaneous Portosystemic Shunts Detected with CT in Patients with Cirrhosis
Relevance of Spontaneous Portosystemic Shunts Detected with CT in Patients with Cirrhosis
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DOI：
10.1148/radiol.2021203051
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发表时间：
2021-04-01
期刊：
影响因子：
19.7
通讯作者：
Schepis, Filippo
中科院分区：
文献类型：
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作者：
Nardelli, Silvia;Riggio, Oliviero;Schepis, Filippo
背景：肝硬化导致门静脉高压，进而形成自发性门体分流（SPSSs），导致门静脉血分流进入体循环相关并发症，称为门体分流综合征。目的：探讨肝硬化合并SPSS患者的特征，评估SPSS对门静脉高压相关并发症和无移植生存的预后影响。材料与方法：A对肝硬化患者（2015 年 3 月至 2019 年 7 月观察）进行回顾性数据库审查，以确定具有 CT 成像和结果数据的患者。收集每位患者的临床和生化数据，并通过 CT 检查 SPSS 的存在、类型和大小。患者的平均随访时间为 27.5 个月 +/- 22.8 个月。使用多变量逻辑分析来确定与 SPSS（任何大小）的存在以及 SPSS 1 厘米或更大的存在相关的临床特征。使用竞争风险分析（Fine 和 Gray 模型）来确定 SPSS 与并发症和死亡率之间的关联。结果：对 222 名肝硬化患者（157 名男性，65 名女性；平均年龄，62 岁 6±12 [标准差]）进行了评估。 222 名患者中有 141 名 (63.5%) 发现 SPSS，222 名患者中有 40 名 (18%) 的分流直径至少为 1 厘米。目前，与 SPSS（任何大小）的存在独立相关的变量是门静脉血栓形成（比值比，5.5；P = .008）和 Child-Pugh C 级（比值比，3.0；P = .03）。既往肝性脑病（比值比，4.4；P = .001）和门静脉血栓形成（比值比，5.3；P = .001）是与大于 1 cm 的 SPSS 相关的唯一变量。任何大小的 SPSS 患者均具有较高的死亡率（亚分布风险比，1.9；P < .001），肝性脑病（亚分布风险比，2.3；P = .023）、胃肠道出血（亚分布风险比，2.9；P = .039）和门静脉血栓形成（亚分布风险比，7.6；P = .039）的发生率较高。 .005).结论：肝硬化患者 CT 图像上出现自发性门体分流与较高的死亡率和并发症相关，包括门静脉血栓、肝性脑病和消化道出血。 (C) 北美放射学会，2021
Background: Cirrhosis leads to portal hypertension and to the consequent formation of spontaneous portosystemic shunts (SPSSs), leading to complications related to the diversion of portal blood into the systemic circulation, which is called portosystemic shunt syndrome.Purpose: To investigate the characteristics of patients with cirrhosis and an SPSS and secondarily to assess the prognostic impact of SPSSs on portal hypertension-related complications and transplant-free survival.Materials and Methods: A retrospective database review of patients with cirrhosis (observed from March 2015 to July 2019) was performed to identify patients with CT imaging and outcomes data. For each patient, clinical and biochemical data were collected, and the presence, types, and sizes of SPSSs were investigated with CT. Patients were followed for a mean of 27.5 months +/- 22.8. Multivariable logistic analysis was used to identify the clinical characteristics associated with the presence of SPSSs (any size) and presence of SPSSs 1 cm or larger. Competitive risk analysis (Fine and Gray model) was used to identify the association between SPSSs and complications and mortality.Results: Two hundred twenty-two patients with cirrhosis (157 male, 65 female; mean age, 62 years 6 12 [standard deviation]) were evaluated. An SPSS was found in 141 of 222 patients (63.5%), and 40 of 222 (18%) had a shunt diameter of at least 1 cm. At presentation, variables independently associated with the presence of SPSSs (any size) were portal vein thrombosis (odds ratio, 5.5; P = .008) and Child-Pugh class C (odds ratio, 3.0; P = .03). Previous hepatic encephalopathy (odds ratio, 4.4; P = .001) and portal vein thrombosis (odds ratio, 5.3; P = .001) were the only variables associated with SPSSs larger than 1 cm. Patients with SPSSs of any size had higher mortality (subdistribution hazard ratio, 1.9; P < .001) and higher frequency of hepatic encephalopathy (subdistribution hazard ratio, 2.3; P = .023), gastrointestinal bleeding (subdistribution hazard ratio, 2.9; P = .039), and portal vein thrombosis (subdistribution hazard ratio, 7.6; P = .005).Conclusion: The presence of spontaneous portosystemic shunts on CT images in patients with cirrhosis was associated with higher mortality and complications, including portal vein thrombosis, hepatic encephalopathy, and gastrointestinal bleeding. (C) RSNA, 2021