TIPS术治疗的肝硬化患者肝性脊髓病临床特征及其影响因素分析*

doi:10.3969/j.issn.1672-5069.2024.03.023

摘要/Abstract

摘要： 目的观察经颈静脉肝内门体分流术(TIPS)治疗的肝硬化并发门静脉脉高压症患者术后肝性脊髓病(HM)的临床特征,并分析HM发病的危险因素。方法 2017年4月～2022年10月我院收治的526例接受过TIPS治疗的肝硬化并发门静脉高压症患者,随访记录术后HM发生情况,应用二元Logistic回归模型分析影响TIPS术后HM发生的危险因素。结果在TIPS术后中位随访28(7～72)个月,发生HM者41例(7.8%),其中男性33例,女性8例,发病年龄为50(40,71)岁;并发肝性脑病(HE)34例(82.9%)、门静脉血栓13例(31.7%)、食管胃底静脉曲张破裂出血6例(14.6%);脊髓功能受损表现为肌力下降31例(75.6%,腱反射亢进21例(51.2%)、肌张力增高23例(56.1%)、病理征阳性22例(53.7%)、主观下肢麻木2例(4.9%)、肛门括约肌功能障碍1例(2.4%);死亡23例;绘制Kaplan-Meier生存曲线,HM患者1 a和3 a累积生存率分别为82.9%和58.5%;随机选择82例未发生HM患者为对照,结果HM组年龄和MELD评分分别为(50.9±12.9)岁和(11.3±2.6)分,显著高于对照组【分别为(47.0±11.3)岁和(10.1±2.1)分,P＜0.05】,HM组男性、脾切除术、发生HE、PT延长和血氨升高占比分别为80.5%、26.8%、82.9%、51.2%和92.2%,显著高于非HM组的61.0%、12.2%、47.6%、31.7%和67.1%(P＜0.05);二元多因素Logistic回归分析显示男性(OR=2.250,95%CI:1.654～3.735)、脾切除术(OR=1.840,95%CI:1.120～2.298)、血氨升高(OR=1.122,95%CI:1.054～1.605)和发生HE(OR=3.442,95%CI:2.248～6.779)是影响TIPS术后发生HM的独立危险因素(P＜0.05)。结论肝硬化门静脉脉高压患者在接受TIPS术后有发生HM的风险,主要见于男性,了解风险因素并予以干预是今后研究的重点。

关键词: 肝硬化, 门静脉脉高压症, 经颈静脉肝内门体分流术, 肝性脊髓病, 危险因素

Abstract: Objective The aim of this study was to summarize the clinical feature and risk factors of hepatic myelopathy (HM) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhotic portal hypertension. Methods The clinical data of 526 patients with cirrhotic portal hypertension were admitted to our hospital between April 2017 and October 2022, and all patients underwent TIPS. The risk factors affecting postoperative HM occurrence were analyzed by using a binary Logistic regression model. Results All patients were followed-up for 7-72 months, with a median of 28 months after TIPS, and the HM was diagnosed in 41 cases (7.8%), male in 33 cases and female in 8 cases, median age of 50(40, 71)yr; the patients with HM had complicated hepatic encephalopathy(HE)in 34 cases (82.9%), portal vein thrombosis (PVT) in 13(31.7%) and esophageal-gastric varices bleeding (EGVB) in 6 cases (14.6%); the main manifestation of HM included decreased muscle strength in 31 cases(75.6%), hyperreflexia in 21 cases (51.2%), increased muscle tone in 23 cases (56.1%), positive pathological signs in 22 cases(53.7%), subjective numbness in 2 cases (4.9%) and anal sphincter dysfunction in 1 case(2.4%); 23 patients with HM died; the one-year and three-year cumulative survival rates were 82.9% and 58.5%; 82 patients from the non-HM group were selected for control, and the ages and the MELD score in patients with HM at admission were(50.9±12.9)year old and (11.3±2.6), both much higher than [(47.0±11.3)year old and (10.1±2.1), P＜0.05] in the control, and the percentages of male, splenectomy, postoperative HE, prolonged PT and elevated blood ammonia levels in patients with HM were 80.5%, 26.8%, 82.9%, 51.2% and 92.2%, significantly higher than 61.0%, 12.2%, 47.6%, 31.7% and 67.1%(P＜0.05) in the control; the binary multivariate Logistic regression model analysis showed the male (OR=2.250, 95%CI:1.654-3.735), splenectomy (OR=1.840, 95%CI;1.120-2.298), elevated blood ammonia level (OR=1.122, 95%CI:1.054-1.605) and HE(OR=3.442, 95%CI:2.248-6.779) were all the risk factors for HM occurrence after TIPS(P＜0.05). Conclusion The male patients with cirrhotic portal vein hypertension could have risk of HM occurrence after TIPS, which should be carefully surveyed and appropriately managed.

Key words: Liver cirrhosis, Portal hypertension, Transjugular intrahepatic portosystemic shunt, Hepatic myelopathy, Risk factors

王修琪, 张裕, 吴一凡, 董成宾, 岳振东, 王成. TIPS术治疗的肝硬化患者肝性脊髓病临床特征及其影响因素分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 410-413.

Wang Xiuqi, Zhang Yu, Wu Yifan, et al. Clinical features and risk factors of hepatic myelopathy after TIPS for in patients with liver cirrhosis and portal hypertension[J]. Journal of Practical Hepatology, 2024, 27(3): 410-413.

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TIPS术治疗的肝硬化患者肝性脊髓病临床特征及其影响因素分析^*

Clinical features and risk factors of hepatic myelopathy after TIPS for in patients with liver cirrhosis and portal hypertension

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