TIPS术后乙型肝炎肝硬化门静脉高压患者显性肝性脑病发生及其危险因素分析*

doi:10.3969/j.issn.1672-5069.2026.01.024

摘要/Abstract

摘要： 目的探讨接受经颈静脉肝内门体分流术(TIPS)术后乙型肝炎肝硬化患者发生显性肝性脑病(OHE)情况及其危险因素。方法 2023年10月～2025年6月我院接受TIPS治疗的乙型肝炎肝硬化并发门静脉高压症患者118例,常规施行TIPS书,应用多因素Logistic回归分析影响OHE发生的因素。结果本组肝硬化患者在TIPS术后发生OHE者27例(22.9%);发生OHE组既往有HE史、Child-Pugh C级和合并肌少症占比分别为25.9%、81.5%和66.7%,均显著高于未发生OHE组的8.8%、22.0%和16.5%,MELD评分、INR、血氨和支架直径分别为16(12,19)分、(1.3±0.2)、(78.5±22.6)μmol/L和(10.4±1.2)mm,均显著高于或大于未发生OHE组【分别为12(10,15)分、(1.2±0.2)、(32.9±9.4)μmol/L和(8.9±1.1)mm,P<0.05】,Δ门静脉压力梯度(ΔPPG)为(10.3±3.6)mmHg,显著大于未发生OHE组【(7.5±3.2)mmHg,P<0.05】;多因素Logistic回归分析显示既往HE史(OR=3.25,P=0.041)、Child-Pugh C级(OR=2.62,P=0.033)、MELD评分升高(OR=1.12,P=0.018)、Alb降低(OR=0.92,P=0.031)、血氨升高(OR=1.28,P=0.004)、存在肌少症(OR=2.15,P=0.048)、TIPS支架直径>10 mm(OR=2.80,P=0.023)和ΔPPG≥10mmHg(OR=3.10,P=0.009)均为影响TIPS术后发生OHE的独立危险因素。结论 TIPS术后肝硬化患者容易发生OHE,了解危险因素并给予适当的防治可能获得更好的治疗效果。

关键词: 肝硬化, 经颈静脉肝内门体分流术, 门静脉高压, 显性肝性脑病, 危险因素

Abstract: Objective The purpose of this study was to investigate prevalence of and risk factors for overt hepatic encephalopathy (OHE) in patients with liver cirrhosis (LC) with portal hypertension (PH) after transjugular intrahepatic portosystemic shunt (TIPS) placement. Methods A total of 118 patients with hepatitis B-induced LC and PH were encountered in our hospital between October 2023 and June 2025, and all underwent TIPS placement routinely. Multivariate Logistic regression analysis was applied to find risk factors for occurrence of OHE. Results The prevalence of OHE was 22.9% after TIPS in our series;percentages of HE history, Child-Pugh class C and sarcopenia in patients with OHE were 25.9%, 81.5% and 66.7%, all significantly higher than 8.8%, 22.0% and 16.5%, and MELD score, INR, blood ammonia and diameter of stents were 16(12,19)points, (1.3±0.2), (78.5±22.6)μmol/L and (10.4±1.2)mm,all significantly higher or greater than [12(10,15)points,(1.2±0.2), (32.9±9.4)μmol/L and (8.9±1.1)mm,P<0.05] in those without OHE, Δportal pressure gradient (ΔPPG) was(10.3±3.6)mmHg, much greater than [(7.5±3.2)mmHg, P<0.05] in those without OHE; multivariate Logistic regression analysis showed that HE history (OR=3.25,P=0.041), Child-Pugh clas C(OR=2.62,P=0.033), MELD score (OR=1.12,P=0.018), serum albumin level (OR=0.92,P=0.031), blood ammonia level (OR=1.28,P=0.004), concomitant sarcopenia (OR=2.15,P=0.048), stent diameter (OR=2.80,P=0.023) and ΔPPG(OR=3.10,P=0.009) were all the independent risk factors for OHE occurrence. Conclusion The occurrence of OHE after TIPS in patients with HBV-induced LC is very common, and appropriate prevention and management might improve patients’quality of life.

Key words: Liver cirrhosis, Portal hypertension, Transjugular intrahepatic portosystemic shunt, Overt hepatic encephalopathy, Risk factors

张俊丽, 汪锐, 何月月, 冯灵. TIPS术后乙型肝炎肝硬化门静脉高压患者显性肝性脑病发生及其危险因素分析^*[J]. 实用肝脏病杂志, 2026, 29(1): 93-96.

Zhang Junli, Wang Rui, He Yueyue, et al. Prevalence of and risk factors for overt hepatic encephalopathy in patients with liver cirrhosis with portal hypertension after TIPS treatment[J]. Journal of Practical Hepatology, 2026, 29(1): 93-96.

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TIPS术后乙型肝炎肝硬化门静脉高压患者显性肝性脑病发生及其危险因素分析^*

Prevalence of and risk factors for overt hepatic encephalopathy in patients with liver cirrhosis with portal hypertension after TIPS treatment

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