门静脉高压行经颈静脉门体分流术后分流道失功的预测模型构建与验证及处理对策

钱景瑜; 杨培培; 张阳; 谢波; 吴迪; 唐孝运; 张雷鸣; 谭玉林; 张子晨

doi:10.16766/j.cnki.issn.1674-4152.004075

门静脉高压行经颈静脉门体分流术后分流道失功的预测模型构建与验证及处理对策

doi: 10.16766/j.cnki.issn.1674-4152.004075

1.
蚌埠医科大学第一附属医院介入科，安徽蚌埠 233004
2.
安徽医科大学第一附属医院介入科，安徽合肥 230032
3.
合肥市第二人民医院介入血管疼痛科，安徽合肥 230011

基金项目:

安徽省高等学校省级质量工程项目 2021jyxm0956

安徽省高校自然科学研究重点项目 KJ2021A0804

安徽省卫生健康科研重点项目 AHWJ2023BAc10022

详细信息

通讯作者:
谭玉林，E-mail：tanyulin2008@163.com

中图分类号: R657.34
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- 文章访问数: 7
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- 被引次数: 0
出版历程
- 收稿日期: 2025-03-16
- 网络出版日期: 2025-10-25

Construction and verification of prediction model and treatment strategy for shunt loss after portal hypertension TIPS

1.
Department of Intervention, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的明确门静脉高压患者行经颈静脉门体分流术(TIPS)术后分流道失功的影响因素，构建并验证临床预测模型，并针对不同类型的分流道失功制定相应的处理对策，为患者提供合理的治疗方案。方法回顾性分析2020年1月—2024年12月在蚌埠医科大学第一附属医院介入科接受TIPS治疗的120例门静脉高压患者的临床资料。根据术后随访结果分为分流道失功组(35例)和未失功组(85例)。将差异有统计学意义的变量纳入多因素logistic回归分析，分析影响分流道失功的独立危险因素，并基于此构建预测模型。通过ROC曲线评估模型区分度；针对不同类型的分流道失功提出相应处理对策。结果多因素logistic回归分析表明，抗凝治疗(OR=15.754, P=0.030)、门静脉血栓(OR=0.052, P=0.008)及门静脉穿刺部位(OR=0.064, P=0.007)为TIPS术后分流道失功的独立影响因素。构建模型的ROC曲线下面积(95% CI)为0.933(0.882~0.983)，最佳界值为0.866，此时灵敏度为0.894, 特异度为0.971。结论抗凝治疗、门静脉血栓及门静脉穿刺部位是TIPS术后分流道失功的独立影响因素，据此构建的预测模型可帮助临床医生早期进行风险分层并采取干预措施。
- 门静脉高压 /
- 经颈静脉门体分流术 /
- 分流道失功 /
- 危险因素 /
- 模型构建与验证
Abstract: Objective To identify the risk factors of shunt dysfunction after transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension, to construct and verify the clinical prediction model, and to formulate corresponding countermeasures for different types of shunt dysfunction, so as to provide reasonable treatment for patients. Methods The clinical data of 120 patients who underwent TIPS in the interventional department of the First Affiliated Hospital of Bengbu Medical University from January 2020 to December 2024 were retrospectively analyzed. Subsequent to the surgical procedure, the subjects were categorized into two distinct groups, namely the shunt dysfunction group and the non-dysfunction group, with the respective numbers amounting to 35 and 85 cases. Variables with significant differences were included in multivariate logistic regression analysis to determine the independent risk factors, and a prediction model was constructed based on this. The discrimination capacity of the model was evaluated by means of the ROC curve. Finally, the corresponding countermeasures are proposed for the various types of shunt failure. Results Multivariate logistic regression analysis demonstrated that anticoagulation therapy (OR=15.754, P=0.030), portal vein thrombosis (OR=0.052, P=0.008) and portal vein puncture site (OR=0.064, P=0.007) were independent influencing factors for shunt dysfunction after TIPS. The area under the ROC curve (95% CI) of the constructed model was 0.933 (0.882-0.983), and the corresponding optimal cut-off value was 0.866. The sensitivity was 0.894, and the specificity was 0.971. Conclusion Therapy, portal vein thrombosis and portal vein puncture site are independent influencing factors of shunt dysfunction after TIPS. The prediction model constructed accordingly has the potential to assist clinicians in the early identification of risks and the implementation of intervention measures.
- Portal hypertension /
- Transjugular intrahepatic portosystemic shunt /
- Stent dysfunction /
- Risk factors /
- Model development and validation

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图 1 模型预测分流道失功的ROC曲线

Figure 1. ROC curve of the model for predicting shunt dysfunction

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图 2 不同类型分流道失功处理

注：A、B为平行TIPS重建分流通道; C、D为原分流道失功球囊扩张。

Figure 2. Treatments for various types of shunt failure

下载: 全尺寸图片幻灯片

表 1 分流道失功组与未失功组门静脉高压患者各项目比较

Table 1. Comparison of parameters between shunt dysfunction and non-dysfunction groups in portal hypertension patients

项目	分流道失功组(n=35)	未失功组(n=85)	统计量	P值
年龄(x±s，岁)	55.26±11.29	56.58±11.00	0.593^a	0.555
性别[例(%)]			0.048^b	0.827
男性	24(68.57)	60(70.59)
女性	11(31.43)	25(29.41)
白蛋白(x±s，g/dL)	30.95±6.35	31.85±6.50	0.696^a	0.488
总胆红素[M(P₂₅, P₇₅), mg/dL]	19.30(14.50, 24.10)	21.50(14.60, 30.50)	-0.546^c	0.585
肌酐[M(P₂₅, P₇₅), mmol/L]	61.00(55.30, 72.60)	62.30(51.95, 74.70)	-0.387^c	0.699
PT[M(P₂₅, P₇₅), s]	15.30(14.60, 17.00)	15.80(14.30, 17.50)	-0.332^c	0.740
AST[M(P₂₅, P₇₅), U/L]	35.80(25.00, 53.00)	33.00(22.00, 42.95)	-1.588^c	0.112
ALT[M(P₂₅, P₇₅), U/L]	28.10(19.00, 47.00)	29.30(19.00, 43.50)	-0.447^c	0.655
PLT[M(P₂₅, P₇₅), ×10⁹/L]	92.00(60.00, 146.00)	76.00(48.50, 107.50)	-1.432^c	0.152
WBC[M(P₂₅, P₇₅), ×10⁹/L]	5.77(3.63, 9.67)	4.90(2.95, 8.41)	-1.365^c	0.172
INR[M(P₂₅, P₇₅)]	1.29(1.19, 1.46)	1.33(1.22, 1.49)	-0.921^c	0.357
糖尿病[例(%)]			97.895^b	< 0.001
否	1(2.86)	81(95.29)
是	34(97.14)	4(4.71)
腹水[例(%)]			1.522^b	0.217
否	13(37.14)	22(25.88)
是	22(62.86)	63(74.12)
门静脉血栓[例(%)]			89.538^b	< 0.001
否	2(5.71)	80(94.12)
是	33(94.29)	5(5.88)
抗凝治疗[例(%)]			97.895^b	< 0.001
否	34(97.14)	4(4.71)
是	1(2.86)	81(95.29)
脾切除(栓塞)史[例(%)]			85.984^b	< 0.001
否	2(5.71)	79(92.94)
是	33(94.29)	6(7.06)
门静脉穿刺部位[例(%)]			85.984^b	< 0.001
非右支	2(5.71)	79(92.94)
右支	33(94.29)	6(7.06)
CT静脉曲张kim分级[M(P₂₅, P₇₅)，级]	3.00(3.00, 3.00)	3.00(3.00, 3.00)	-0.216^c	0.829
Child分级[M(P₂₅, P₇₅)，级]	2.00(2.00, 2.00)	2.00(2.00, 2.00)	-0.422^c	0.673
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 门静脉高压患者TIPS术后分流道失功影响因素的logistic回归分析

Table 2. Logistic regression analysis of factors influencing shunt dysfunction after TIPS in patients with portal hypertension

变量	B	SE	Waldχ²	P值	OR值	95% CI
抗凝治疗	2.757	1.274	4.683	0.030	15.754	1.297~191.387
门静脉血栓	-2.957	1.106	7.143	0.008	0.052	0.006~0.455
门静脉穿刺部位	-2.749	1.011	7.397	0.007	0.064	0.009~0.464
截距	2.610	1.204	4.700	0.030	13.597	1.285~143.904

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