Trend of serum bilirubin in patients with portal hypertension treated with transjugular intrahepatic portosystemic shunt_West China Medical Journal

Authors：

SONG Wenli , YAO Yong , LIU Tianyu , FENG Lei , XU Jianyu , HE Suyu ,  CHEN Yongjun

Department of Gastroenterology, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;

Corresponding?author：

CHEN Yongjun, Email: snszxyy@126.com

Keywords：

Transjugular intrahepatic portosystemic shunt; Portal hypertension; Serum bilirubin; Trend

DOI：

10.7507/1002-0179.201903108

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Objective To investigate the trend of serum bilirubin in patients with liver cirrhosis before and after transjugular intrahepatic portosystemic shunt (TIPS).Methods The data of patients with cirrhotic portal hypertension who underwent TIPS between October 2016 and June 2018 were collected retrospectively, including liver function before and after surgery (1 week, 1 month, 3 months, and 6 months after surgery), preoperative and postoperative portal vein pressure, and the Child-Pugh scores, model for end-stage liver disease (MELD) scores, and albumin-bilirubin (ALBI) scores. Paired t-test was used for the statistical measurement data. The total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels at five time points were analyzed by analysis of variance of repeated measurement data with its own before and after comparison, and Wilcoxon signed ranks test was used for the ordered data.Results A total of 60 patients were included.The portal vein pressure was (27.86±2.53) mm Hg (1 mm Hg=0.133 kPa) before TIPS and (17.22±2.33) mm Hg after TIPS, and the difference was statistically significant (P<0.05). The common logarithm of the serum TBIL level [lg(TBIL)] before surgery and 1 week, 1 month, 3 months, and 6 months after surgery were (1.27±0.23), (1.44±0.21), (1.51±0.20), (1.56±0.22), (1.48±0.19) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). The common logarithm of the serum DBIL level [lg(DBIL)] at the five time periods were (0.90±0.26), (1.14±0.24), (1.18±0.25), (1.21±0.28), (1.08±0.21) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). The common logarithm of the serum IBIL level [lg(IBIL)] at the five time periods were (1.00±0.23), (1.13±0.22), (1.20±0.23), (1.26±0.21), (1.22±0.23) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). There were no statistically significant differences in the three liver reserve function scores (Child-Pugh, MELD, and ALBI, respectively) before and six months after operation (P>0.05). The differences in the composition of Child-Pugh and ALBI before and after surgery were not statistically significant (P>0.05).Conclusions TIPS has a significant effect on reducing portal hypertension. Serum bilirubin levels continue to increase during a period after TIPS, but begin to decrease within 6 months.

Citation： SONG Wenli, YAO Yong, LIU Tianyu, FENG Lei, XU Jianyu, HE Suyu, CHEN Yongjun. Trend of serum bilirubin in patients with portal hypertension treated with transjugular intrahepatic portosystemic shunt. West China Medical Journal, 2019, 34(7): 807-812. doi: 10.7507/1002-0179.201903108 Copy

1.	Qin JP, Jiang MD, Tang W, et al. Clinical effects and complications of TIPS for portal hypertension due to cirrhosis: a single center. World J Gastroenterol, 2013, 19(44): 8085-8092.
2.	Bucsics T, Schoder M, Goeschl N, et al. Re-bleeding rates and survival after early transjugular intrahepatic portosystemic shunt (TIPS) in clinical practice. Digest Liver Dis, 2017, 49(12): 1360-1367.
3.	Munawwar A, Nidugala KS, Vinu M, et al. Transjugular intrahepatic portosystemic shunt through the strut of a previously placed stent: technical feasibility and long-term follow-up results. Cardiovasc Intervent Radiol, 2018, 41(11): 1794-1798.
4.	Shah RP, Sze DY. Complications during transjugular intrahepatic portosystemic shunt creation. Tech Vasc Interv Radiol, 2016, 19(1): 61-73.
5.	庹琳, 湯善宏, 曾維政, 等. 經頸靜脈肝內門體分流術并發癥的處理及預防措施. 臨床肝膽病雜志, 2016, 32(2): 354-357.
6.	Casadaban LC, Parvinian A, Couture PM, et al. Characterization of liver function parameter alterations after transjugular intrahepatic portosystemic shunt creation and association with early mortality. Ame J Roentgenol, 2014, 203(6): 1363-1370.
7.	晏楠, 白云飛, 單志剛, 等. 經頸內靜脈肝內門體靜脈分流術后肝性腦病危險因素分析. 臨床誤診誤治, 2015(7): 39-43.
8.	胡維林, 羅小平, 石小楓, 等. 經頸靜脈肝內門體分流術治療肝硬化頑固性腹水臨床療效及預后因素分析. 重慶醫科大學學報, 2015(3): 392-398.
9.	陳斯良, 胡朋, 林志鵬, 等. TIPS術后短期總膽紅素顯著升高的相關因素分析及其對生存預后的影響. 中華介入放射學電子雜志, 2018, 6(1): 40-45.
10.	Fonio P, Discalzi A, Calandri M, et al. Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) according to its severity and temporal grading classification. Radiol Med, 2017, 122(9): 713-721.
11.	Rajan DK, Haskal ZJ, Clark TW. Serum bilirubin and early mortality after transjugular intrahepatic portosystemic shunts: Results of a multivariate analysis. J Vasc Interv Radiol, 2002, 13(2 Pt 1): 155-161.
12.	Saxon RR, Mendel-Hartvig J, Corless CL, et al. Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts:comparative histopathologic analysis in humans and swine. J Vasc Interv Radiol, 1996, 7(4): 487-497.
13.	宦徽, 童歡, 魏波, 等. 經頸靜脈肝內門體靜脈分流術聯合胃左靜脈栓塞術對肝硬化患者肝功能的影響. 中華消化雜志, 2017, 37(6): 404-410.
14.	中華醫學會肝病學分會, 中華醫學會消化病學分會, 中華醫學會內鏡學分會. 肝硬化門靜脈高壓食管胃靜脈曲張出血防治指南(2015). 中華胃腸內鏡電子雜志, 2015, 2(4): 1-21.
15.	中華醫學會消化病學分會消化介入學組. 經頸靜脈肝內門體靜脈分流術治療肝硬化門靜脈高壓共識意見. 臨床肝膽病雜志, 2014, 30(3): 210-213.
16.	中華醫學會肝病學分會. 肝硬化腹水及相關并發癥的診療指南. 中華肝臟病雜志, 2017, 25(9): 664-677.
17.	Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
18.	Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology, 2001, 33(2): 464-470.
19.	Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach--The ALBI grade. J Clin Oncol, 2015, 33(6): 550-558.
20.	陳輝, 呂勇, 王秋和, 等. 經頸靜脈肝內門體分流術專家共識. 臨床肝膽病雜志, 2017, 33(7): 1218-1228.
21.	陳曉平, 汪建平. 外科學. 8版. 北京: 人民衛生出版社, 2013: 437.
22.	林佳媛. 膽紅素代謝及其調節的研究進展. 復旦學報(醫學版), 2014, 41(3): 405-411.
23.	Akamatsu Y, Ohkohchi N, Seya K, et al. Analysis of bilirubin fraction in the bile for early diagnosis of acute rejection in living related liver transplantation. Tohoku J Exp Med, 1997, 181(1): 145-154.

1. Qin JP, Jiang MD, Tang W, et al. Clinical effects and complications of TIPS for portal hypertension due to cirrhosis: a single center. World J Gastroenterol, 2013, 19(44): 8085-8092.
2. Bucsics T, Schoder M, Goeschl N, et al. Re-bleeding rates and survival after early transjugular intrahepatic portosystemic shunt (TIPS) in clinical practice. Digest Liver Dis, 2017, 49(12): 1360-1367.
3. Munawwar A, Nidugala KS, Vinu M, et al. Transjugular intrahepatic portosystemic shunt through the strut of a previously placed stent: technical feasibility and long-term follow-up results. Cardiovasc Intervent Radiol, 2018, 41(11): 1794-1798.
4. Shah RP, Sze DY. Complications during transjugular intrahepatic portosystemic shunt creation. Tech Vasc Interv Radiol, 2016, 19(1): 61-73.
5. 庹琳, 湯善宏, 曾維政, 等. 經頸靜脈肝內門體分流術并發癥的處理及預防措施. 臨床肝膽病雜志, 2016, 32(2): 354-357.
6. Casadaban LC, Parvinian A, Couture PM, et al. Characterization of liver function parameter alterations after transjugular intrahepatic portosystemic shunt creation and association with early mortality. Ame J Roentgenol, 2014, 203(6): 1363-1370.
7. 晏楠, 白云飛, 單志剛, 等. 經頸內靜脈肝內門體靜脈分流術后肝性腦病危險因素分析. 臨床誤診誤治, 2015(7): 39-43.
8. 胡維林, 羅小平, 石小楓, 等. 經頸靜脈肝內門體分流術治療肝硬化頑固性腹水臨床療效及預后因素分析. 重慶醫科大學學報, 2015(3): 392-398.
9. 陳斯良, 胡朋, 林志鵬, 等. TIPS術后短期總膽紅素顯著升高的相關因素分析及其對生存預后的影響. 中華介入放射學電子雜志, 2018, 6(1): 40-45.
10. Fonio P, Discalzi A, Calandri M, et al. Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) according to its severity and temporal grading classification. Radiol Med, 2017, 122(9): 713-721.
11. Rajan DK, Haskal ZJ, Clark TW. Serum bilirubin and early mortality after transjugular intrahepatic portosystemic shunts: Results of a multivariate analysis. J Vasc Interv Radiol, 2002, 13(2 Pt 1): 155-161.
12. Saxon RR, Mendel-Hartvig J, Corless CL, et al. Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts:comparative histopathologic analysis in humans and swine. J Vasc Interv Radiol, 1996, 7(4): 487-497.
13. 宦徽, 童歡, 魏波, 等. 經頸靜脈肝內門體靜脈分流術聯合胃左靜脈栓塞術對肝硬化患者肝功能的影響. 中華消化雜志, 2017, 37(6): 404-410.
14. 中華醫學會肝病學分會, 中華醫學會消化病學分會, 中華醫學會內鏡學分會. 肝硬化門靜脈高壓食管胃靜脈曲張出血防治指南(2015). 中華胃腸內鏡電子雜志, 2015, 2(4): 1-21.
15. 中華醫學會消化病學分會消化介入學組. 經頸靜脈肝內門體靜脈分流術治療肝硬化門靜脈高壓共識意見. 臨床肝膽病雜志, 2014, 30(3): 210-213.
16. 中華醫學會肝病學分會. 肝硬化腹水及相關并發癥的診療指南. 中華肝臟病雜志, 2017, 25(9): 664-677.
17. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
18. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology, 2001, 33(2): 464-470.
19. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach--The ALBI grade. J Clin Oncol, 2015, 33(6): 550-558.
20. 陳輝, 呂勇, 王秋和, 等. 經頸靜脈肝內門體分流術專家共識. 臨床肝膽病雜志, 2017, 33(7): 1218-1228.
21. 陳曉平, 汪建平. 外科學. 8版. 北京: 人民衛生出版社, 2013: 437.
22. 林佳媛. 膽紅素代謝及其調節的研究進展. 復旦學報(醫學版), 2014, 41(3): 405-411.
23. Akamatsu Y, Ohkohchi N, Seya K, et al. Analysis of bilirubin fraction in the bile for early diagnosis of acute rejection in living related liver transplantation. Tohoku J Exp Med, 1997, 181(1): 145-154.

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Trend of serum bilirubin in patients with portal hypertension treated with transjugular intrahepatic portosystemic shunt

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