Objective: To explore pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) severity grading to predict the prognostic value for PA-HSOS patients treated with transjugular intrahepatic portosystemic shunt (TIPS). Methods: Clinical data of patients with PA-HSOS who were critically ill or had ineffective drug treatment and underwent TIPS treatment from December 2013 to September 2019 were retrospectively analyzed. PA-HSOS severity grading criteria in adult was quoted, revised and defined from the European Group for Blood and Marrow Transplantation (EBMT). The survival time, the rate of shunt dysfunction and the incidence of postoperative hepatic encephalopathy in different severity groups after TIPS were compared. Univariate Cox or Binomial Logistic regression analysis was used to evaluate the impact of each variable. Variables with P < 0.1 were regarded as statistically significant variables for the prognosis, and were introduced into Cox or Binomial Logistic regression hierarchical regression analysis as controlled covariates. PA-HSOS severity grading was analyzed as dummy variables. Results: A total of 102 patient data were collected, and the median follow-up time was 14.52 months. The difference in survival time of patients with different severity levels was statistically significant (P = 0.023). The mortality risk in moderate patients was 1.575 times higher than that of mild patients (95%CI: 0.216-11.457, P = 0.654). The mortality risk of severe and very severe patients was 7.424 times higher than that of mild patients (95% CI: 1.612-34.197, P = 0.010). There was no statistically significant difference in postoperative hepatic encephalopathy recurrence rate and shunt dysfunction rate (P > 0.05). Conclusion: PA-HSOS severity grading has prognostic value for PA-HSOS patients receiving TIPS treatment, and can be used as an important reference for guiding the timing of TIPS intervention.
目的： 探究吡咯生物碱相关肝窦阻塞综合征(PA-HSOS)严重度分级对经颈静脉肝内门体分流术（TIPS）治疗PA-HSOS患者预后的预测价值。 方法： 回顾性分析2013年12月至2019年9月间危重或药物治疗无效，行TIPS治疗的PA-HSOS患者的临床资料。PA-HSOS患者的严重程度分级参考欧洲血液及骨髓移植协作组成人可疑肝窦阻塞综合征新严重度分级标准并做适当修改和定义，比较不同严重程度患者TIPS治疗后生存时间、分流道失功能发生率及术后肝性脑病发生率的差别。采用单因素Cox或二项logistic回归分析评估各个变量对于结局的影响，将P < 0.1的变量作为对于结局有统计学意义的变量，作为协变量引入Cox或二项logistic回归分层回归分析后予以控制，将PA-HSOS严重度分级作为哑变量进行分析。 结果： 共收集102例患者资料,中位随访时间为14.52个月。不同严重度患者的生存时间差异有统计学意义（P = 0.023），中度患者的死亡风险是轻度患者的1.575倍（95%CI：0.216～11.457，P = 0.654）;重度和极重度患者的死亡风险是轻度患者的7.424倍(95%CI：1.612～34.197，P = 0.010），术后肝性脑病再发率、分流道失功能发生率差异均无统计学意义（P值均> 0.05)。 结论： PA-HSOS严重度分级对TIPS术治疗的PA-HSOS患者结局有预测价值，可以作为指导TIPS干预时机的一个重要参考。.
Keywords: Hepatic sinusoidal obstruction syndrome; PA-HSOS criteria for severity grading; Pyrrolizidine alkaloids; Transjugular intrahepatic portosystemic shunt.