合并少肌症对肝硬化患者行经颈静脉肝内门体分流术后发生肝性脑病的影响

Sarcopenia may predict the occurrence of hepatic encephalopathy in patients with liver cirrhosis after transjugular intrahepatic portosystemic shunt

目的探讨合并少肌症对于肝硬化患者行经颈静脉肝内门体分流术后发生肝性脑病的影响。方法回顾性分析2015年1月至2019年8月行经颈静脉肝内门体分流术的患者301例,收集其术前及术后资料,通过CT图像及软件分析测量L3层面的骨骼肌面积定义骨骼肌质量指数,采用二元Logistic回归分析发生肝性脑病的危险因素。结果接受经颈静脉肝内门体分流术的肝硬化患者中,少肌症的发生率为63.8%(192/301)。年龄(OR:1.088,95%CI:1.024~1.156)、MELD评分(OR:1.004,95%CI:1.003~1.005)、HE病史(OR:1.922,95%CI:1.487~2.357)及合并少肌症(OR:2.745,95%CI:2.311~2.902)是术后HE发生的独立危险因素。结论经颈静脉肝内门体分流术,术前合并少肌症可预测肝硬化患者经颈静脉肝内门体分流术后术后肝性脑病的发生。

Objective To investigate the predictive value of sarcopenia on the occurrence of hepatic encephalopathy(HE)in patients with liver cirrhosis after transjugular intrahepatic portosystemic shunt(TIPSS).Methods A retrospective analysis of 301 patients who underwent TIPSS therapy from January 2015 to August 2019 were enrolled in these study.The skeletal muscle areas of the patients at the L3 level were measured by CT images and were analyzed by software to define sarcopenia.Risk factors for HE were analyzed by binary logistic regression.Results Among patients with liver cirrhosis who underwent TIPPS,the incidence of sarcopenia was 63.8%.Age(OR:1.088,95%CI:1.024-1.156),MELD score(OR:1.004,95%CI:1.003-1.005),HE history(OR:1.922,95%CI:1.487-2.357)and sarcopenia(OR:2.745,95%CI:2.311-2.902)were independent risk factors for postoperative HE.Conclusion The incidence of sarcopenia in cirrhotic patients underwent TIPSS is relatively high.Sarcopenia may predict the occurrence of HE in liver cirrhotic patients after TIPSS surgery.Caution should be taken on such patients.