乙型肝炎肝硬化患者肌少症发生率及其对TIPS术后发生肝性脑病的影响*

doi:10.3969/j.issn.1672-5069.2026.03.019

实用肝脏病杂志 ›› 2026, Vol. 29 ›› Issue (3): 393-396.doi: 10.3969/j.issn.1672-5069.2026.03.019

乙型肝炎肝硬化患者肌少症发生率及其对TIPS术后发生肝性脑病的影响^*

董丽, 胡成文, 张永慧, 成德雷, 周春泽, 殷亮

230000 安徽省合肥市安徽医科大学护理学院(董丽,胡成文);中国科学技术大学附属第一医院/安徽省立医院介入科(张永慧,成德雷,周春泽,殷亮)

收稿日期:2025-04-28 出版日期:2026-05-10 发布日期:2026-05-18
通讯作者: 胡成文,E-mail:huchengwen318@126.com
作者简介:董丽,女,33岁,硕士研究生。E-mail:18356015766@163.com
基金资助:
^*安徽省合肥市自然科学基金资助项目(编号:20230041)

Prevalence of sarcopenia in patients with hepatitis B-induced liver cirrhosis and its impact on occurrence of hepatic encephalopathy after TIPS

Dong Li, Hu Chengwen, Zhang Yonghui, et al

Anhui Medical University School of Nursing, Department of Interventional Radiology, Anhui Provincial Hospital, First Affiliated Hospital, University of Science and Technology of China, Hefei 230000, Anhui Province, China

Received:2025-04-28 Online:2026-05-10 Published:2026-05-18

摘要/Abstract

摘要： 目的评估肌肉减少症(Sp)对接受经颈静脉肝内门体分流术(TIPS)治疗的乙型肝炎肝硬化患者术后发生肝性脑病(HE)的影响。方法 2019年3月～2022年12月中国科学技术大学附属第一医院接受TIPS治疗的128例乙型肝炎肝硬化患者,采用脐平面CT图像测量右侧腰大肌最大横径/身高(TPMT/H)评估和诊断Sp。采用Cox回归分析影响HE发生的危险因素。结果 CT检测发现Sp者54例(42.2%);Sp患者年龄和血氨水平分别为(56.3±11.8)岁和(56.3±22.2)μmol/L,均显著大于或高于非Sp患者【分别为(50.2±10.6)岁和(48.6±20.4)μmol/L,P<0.05】,而TPMT/H和血清白蛋白水平分别为(14.2±1.9)mm/m和(30.9±5.3)g/L,均显著低于非Sp组【分别为(19.9±2.3)mm/m和(33.1±5.6)g/L,P<0.05】;在术后6个月,Sp患者HE发生率为53.7%,显著高于非Sp患者的16.2%(P<0.001);TIPS术后发生HE患者年龄、血氨水平、Child-Pugh评分、MELD评分和TPMT/H与未发生HE患者比,差异均有统计学意义(P<0.05);单因素Cox回归分析显示上述因素均为影响HE发生的危险因素(P<0.05),而多因素回归分析显示只有TPMT/H为影响HE发生的独立危险因素(HR=0.779,95%CI:0.708～0.858,P<0.001)。结论乙型肝炎肝硬化患者Sp发生率较高,可能诱发TIPS术后HE的发生,需引起临床的重视。

关键词: 肝硬化, 肌肉减少症, 经颈静脉肝内门体分流术, 肝性脑病

Abstract: Objective The aim of this study was to investigate the prevalence of sarcopenia (Sp) in patients with hepatitis B-induced liver cirrhosis(LC) and its impact on occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS). Methods This retrospective study included 128 patients with hepatitis B-induced LC who underwent TIPS at the First Affiliated Hospital, University of Science and Technology of China between March 2019 and December 2022. Sp was diagnosed by measurement and calculation of the ratio of the maximal transverse diameter of the right psoas muscle at the umbilical level on CT images to height (TPMT/H), with a cutoff value of ≤16.8 mm/m. Risk factors for HE were analyzed by using Cox regression models. Patients were followed-up until March 2024,with a median follow-up period of 39(15,60) months. Results Of the 128 patients, Sp was found in 54 cases (42.2%); age and blood ammonia levels in patients with Sp were (56.3±11.8) yr and (56.3±22.2)μmol/L, both significantly older or higher than [(50.2±10.6) yr and (48.6±20.4)μmol/L, respectively, P<0.05], while TPMT/H ratio and serum albumin levels were (14.2±1.9)mm/m and (30.9±5.3)g/L, both significantly lower than [(19.9±2.3)mm/m and (33.1±5.6)g/L, respectively, P<0.05] in those without Sp; by end of 6-month of follow-up, the incidence of HE after TIPS in Sp group was 53.7%, much higher than 16.2% (P<0.001) in patients without Sp; patients with HE after TIPS had significantly older age, high blood ammonia levels, Child-Pugh scores, MELD scores and lower TPMT/H ratio compared to those without HE (P<0.05); Cox univariate analysis identified these factors as significantly associated with HE occurrence (P<0.05), and multivariate Cox analysis revealed only TPMT/H as the independent predictor for post-TIPS HE (HR=0.779,95% CI: 0.708-0.858, P<0.001). Conclusion Sp is highly prevalent among patients with hepatitis B-induced LC, which might greatly increases the risk of HE after TIPS.

Key words: Liver Cirrhosis, Sarcopenia, Transjugular intrahepatic portosystemic shunt, Hepatic encephalopathy

董丽, 胡成文, 张永慧, 成德雷, 周春泽, 殷亮. 乙型肝炎肝硬化患者肌少症发生率及其对TIPS术后发生肝性脑病的影响^*[J]. 实用肝脏病杂志, 2026, 29(3): 393-396.

Dong Li, Hu Chengwen, Zhang Yonghui, et al. Prevalence of sarcopenia in patients with hepatitis B-induced liver cirrhosis and its impact on occurrence of hepatic encephalopathy after TIPS[J]. Journal of Practical Hepatology, 2026, 29(3): 393-396.

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乙型肝炎肝硬化患者肌少症发生率及其对TIPS术后发生肝性脑病的影响^*

Prevalence of sarcopenia in patients with hepatitis B-induced liver cirrhosis and its impact on occurrence of hepatic encephalopathy after TIPS

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