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