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The role of a multidisciplinary team in the management of portal hypertension

多学科团队在门脉高压症管理中的作用

  • 影响因子:2.76
  • DOI:10.1186/s12876-020-01203-4
  • 作者列表:"Yujen Tseng","Lili Ma","Minzhi Lv","Tiancheng Luo","Chengfeng Liu","Yichao Wei","Chu Liu","Ji Zhou","Zhiping Yan","Pengju Xu","Guohua Hu","Hong Ding","Yuan Ji","Shiyao Chen","Jian Wang
  • 发表时间:2020-04-03
Abstract

Abstract Background Gastroesophageal variceal hemorrhage is the most severe complication of portal hypertension, with a high mortality rate. The current recommendations for gastroesophageal varices include pharmacological treatment, endoscopic treatment, transjugular intrahepatic portosystemic shunt (TIPS) placement, and splenectomy with devascularization surgery. Multidisciplinary team (MDT) comprises of a group of medical experts and specialists across a range of disciplines, providing personalized and targeted patient care tailored to each individual’s condition, circumstances, and expectations. Methods Patients referred to the MDT clinic since its establishment in September 2014 were prospectively enrolled and followed-up for at least 12 months. Patient baseline characteristics, treatment methods, outcome and survival were compared to non-MDT patients retrieved from a prospectively maintained database with propensity score matching. Results Propensity-score matching (PSM) was carried out to balance available covariates, resulting in 58 MDT patients vs. 111 non-MDT patients. Overall survival and variceal rebleed was compared between the two groups. The rate of variceal rebleed was significantly higher in the non-MDT group, while no difference in overall survival was observed. Conclusions This study is the first to investigate the role of a multidisciplinary team in the management of gastroesophageal varices secondary to portal hypertension. Patients treated based on MDT clinic recommendations had a significantly lower risk for variceal rebleed.

摘要

背景食管胃底静脉曲张破裂出血是门静脉高压症最严重的并发症,具有较高的死亡率。目前对胃食管静脉曲张的推荐包括药物治疗、内镜治疗、经颈静脉肝内门体分流术 (TIPS) 放置和脾切除加断流术。多学科团队 (MDT) 由一系列学科的医学专家和专家组成,根据每个人的病情、情况和期望提供个性化和有针对性的患者护理。方法前瞻性纳入 2014年9月 MDT 门诊建站以来转诊的患者,随访至少 12 个月。将患者基线特征、治疗方法、结局和生存率与从倾向评分匹配的前瞻性维护数据库中检索的非 MDT 患者进行比较。结果进行倾向评分匹配 (PSM) 以平衡可用的协变量,导致 58 例 MDT 患者 vs. 111 例非 MDT 患者。比较两组的总生存率和静脉曲张再出血。非 MDT 组的静脉曲张再出血率显著较高,而总生存率无差异。结论本研究首次调查了多学科团队在治疗继发于门静脉高压的胃食管静脉曲张中的作用。根据 MDT 临床建议治疗的患者静脉曲张再出血风险显著降低。

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影响因子:3.87
发表时间:2020-02-01
DOI:10.1111/liv.14321
作者列表:["Chen VL","Chen Y","Du X","Handelman SK","Speliotes EK"]

METHODS:BACKGROUND AND AIMS:Cirrhosis is characterized by extensive fibrosis of the liver and is a major cause of liver-related mortality. Cirrhosis is partially heritable but genetic contributions to cirrhosis have not been systemically explored. Here, we carry out association analyses with cirrhosis in two large biobanks and determine the effects of cirrhosis associated variants on multiple human disease/traits. METHODS:We carried out a genome-wide association analysis of cirrhosis as a diagnosis in UK BioBank (UKBB; 1088 cases vs. 407 873 controls) and then tested top-associating loci for replication with cirrhosis in a hospital-based cohort from the Michigan Genomics Initiative (MGI; 875 cases of cirrhosis vs. 30 346 controls). For replicating variants or variants previously associated with cirrhosis that also affected cirrhosis in UKBB or MGI, we determined single nucleotide polymorphism effects on all other diagnoses in UKBB (PheWAS), common metabolic traits/diseases and serum/plasma metabolites. RESULTS:Unbiased genome-wide association study identified variants in/near PNPLA3 and HFE, and candidate variant analysis identified variants in/near TM6SF2, MBOAT7, SERPINA1, HSD17B13, STAT4 and IFNL4 that reproducibly affected cirrhosis. Most affected liver enzyme concentrations and/or aspartate transaminase-to-platelet ratio index. PheWAS, metabolic trait and serum/plasma metabolite association analyses revealed effects of these variants on lipid, inflammatory and other processes including new effects on many human diseases and traits. CONCLUSIONS:We identified eight loci that reproducibly associate with population-based cirrhosis and define their diverse effects on human diseases and traits.

翻译标题与摘要 下载文献
影响因子:2.57
发表时间:2020-02-01
DOI:10.1111/eci.13198
作者列表:["Li H","Wieser A","Zhang J","Liss I","Markwardt D","Hornung R","Neumann-Cip AC","Mayerle J","Gerbes A","Steib CJ"]

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