vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2021-18-3-362-374vestim-787Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEИспользование лапароцентеза при лечении асцита у пациентов с циррозом печениUse of laparocentesis in the treatment of ascites in patients with liver cirrhosishttps://orcid.org/0000-0001-7542-0980МогилевецЭ. В.MahiliavetsE. V.

Могилевец Эдуард Владиславович – канд. мед. наук, доцент, заведующий кафедрой

ул. Горького, 80, 230009, г. Гродно

Eduard V. Mahiliavets – Ph. D. (Med.), Associate Professor, Head of the Department

80, Gorky Str., 230009, Grodno 

emogilevec@yandex.ruБожкоЕ. Н.BozhkoY. N.

Божко Елена Николаевна – заведующий отделением

проспект Янки Купалы, 89, 230026, г. Гродно

Yelena N. Bozhko – Head of the Department

89, Yanka Kupala Ave., 230026, Grodno 

gastro@gkb4.byМогилевецО. Н.MahiliavetsO. N.

Могилевец Ольга Николаевна – канд. мед. наук, доцент

ул. Горького, 80, 230009, г. Гродно

Olga N. Mahiliavets – Ph. D. (Med.), Associate Professor

80, Gorky Str., 230009, Grodno 

modened@yandex.ruГродненский государственный медицинский университетGrodno State Medical UniversityГородская клиническая больница № 4City Clinical Hospital No. 4202106092021183362374Copyright © Могилевец Э.В., Божко Е.Н., Могилевец О.Н., 20212021Могилевец Э.В., Божко Е.Н., Могилевец О.Н.Mahiliavets E.V., Bozhko Y.N., Mahiliavets O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/787

Асцит встречается примерно у 60 % пациентов с циррозом печени в течение 10 лет после установления диагноза. У пациентов с рефрактерным асцитом предпочтительным методом первой линии терапии является лапароцентез, позволяющий одномоментно удалить более 5–6 л асцитической жидкости. Актуальными являются поиск информативных прогностических факторов и разработка метода прогнозирования неблагоприятных исходов повторных лапароцентезов у пациентов с рефрактерным асцитом с целью своевременного их направления для выполнения TIPS.Цель исследования – разработать модель определения вероятности неблагоприятных исходов лапароцентеза у пациентов с асцитом на фоне цирроза печени и оценить ее диагностическую значимость.Изучены результаты лечения 99 пациентов с асцитическим синдромом на фоне внутрипеченочной портальной гипертензии. Для расчета моделей прогнозирования проводили множественный регрессионный анализ с использованием логит-модели бинарных откликов.Проведенный анализ результатов лечения пациентов с циррозом печени и асцитом методом лапароцентеза позволил выявить факторы, которые оказывают влияние на наступление неблагоприятного исхода. Наиболее перспективными для прогнозирования представляются две модели с включением исходных переменных: модель А – вес пациента, сывороточно-асцитический градиент общего белка, гипонатриемия; модель В – балльная оценка по шкале MELD-Na, сывороточно-асцитический градиент общего белка, вес пациента. Разработанные способы прогнозирования являются высокоинформативными, эффективными, доступными и могут найти широкое применение в клинической практике.Возможность прогнозирования неблагоприятного исхода у пациентов с портальной гипертензией и асцитом после лапароцентеза позволяет осуществлять своевременный персонифицированный выбор наиболее действенных, но и более дорогостоящих методов лечения, таких как TIPS, что будет способствовать повышению эффективности терапии и выживаемости данного контингента пациентов.

Ascites occurs in about 60 % of patients with cirrhosis within 10 years of diagnosis. Laparocentesis is the preferred first-line therapy in patients with cirrhosis and massive tense ascites, allowing more than 5–6 liters of ascitic fluid to be removed at one time. The search for informative prognostic factors and the development of a method for predicting unfavorable outcomes of repeated laparocenteses in patients with ascites are relevant to timely refer this contingent of patients to perform TIPS.The purpose of the study was to develop and evaluate the diagnostic significance of a model for determining the probability of unfavorable outcomes of laparocentesis in patients with ascites on the background of liver cirrhosis.The results of treatment of 99 patients with the ascitic syndrome associated with intrahepatic portal hypertension were studied. The multiple regression analysis using the binary response logit model was carried out to calculate the prediction models. The analysis of the treatment results of patients with liver cirrhosis and ascites by the laparocentesis method revealed a number of factors that influence the onset of an unfavorable outcome. 2 models with the inclusion of initial variables are the most promising for forecasting. Model A includes: patient weight, serum-ascites total protein gradient, hyponatremia; model B: MELD-Na score, serum-ascitic total protein gradient, patient weight. The developed prediction method is highly informative, effective, easily applicable, and can be widely used in clinical practice.The ability to predict an unfavorable outcome in patients with portal hypertension and ascites after laparocentesis allows for a personalized approach in the process of timely selection of more effective, but also more expensive treatment methods, such as TIPS, which will help us to increase the therapy effectiveness and the survival of this cohort of patients.

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The authors declare that there are no conflicts of interest present.