摘要
Background and aims:Hepatic encephalopathy is a common complication encountered in patients with liver cirrhosis.Hepatic encephalopathy is not reflected in the current liver transplant allocation system.Correlation was sought between hepatic encephalopathy with findings detected on radiographic imaging studies and the patient’s clinical profile.Methods:A retrospective analysis was conducted of patients with cirrhosis,who presented for liver transplant evaluation in 2009 and 2010.Patients with hepatocellular carcinoma,ejection fraction less than 60%and who had a TIPS(transjugular intrahepatic portosystemic shunting)procedure or who did not complete the evaluation were excluded.Statistical analysis was performed and variables found to be significant on univariate analysis(P<0.05)were analysed by a multivariate logistic regression model.Results:A total of 117 patients met the inclusion criteria and were divided into a hepatic encephalopathy group(n=58)and a control group(n=59).Univariate analysis found that a smaller portal vein diameter,smaller liver antero-posterior diameter,liver nodularity and use of diuretics or centrally acting medications showed significant correlation with hepatic encephalopathy.This association was confirmed for smaller portal vein,use of diuretics and centrally acting medications in the multivariate analysis.Conclusion:A decrease in portal vein diameter was associated with increased risk of encephalopathy.Identifying patients with smaller portal vein diameter may warrant screening for encephalopathy by more advanced psychometric testing,and more aggressive control of constipation and other factors that may precipitate encephalopathy.
背景与目的:肝性脑病是肝硬化患者的常见并发症,而肝性脑病患者目前并不适宜进行肝移植。本研究旨在明确影像学提示的肝性脑病与患者临床特征的关系。方法:回顾性分析2009-2010年间进行肝移植评估的肝硬化患者。排除肝癌、射血分数不足60%、曾行经颈静脉肝内门体分流术以及未完成评估的患者。单因素分析有统计学意义(P<0.05)的变量纳入多因素逻辑回归模型。结果:共计117例肝硬化患者满足纳入标准入组研究,其中肝性脑病组58例,对照组59例。单因素分析显示,门静脉直径较小、肝前后径较短、肝结节、应用利尿剂/中枢作用药物与肝性脑病的发生密切相关。多因素分析证实了门静脉直径和应用利尿剂/中枢作用药物与肝性脑病的关系。结论:门静脉直径缩小提示肝性脑病的风险增加。找出门静脉直径较小的肝硬化患者,通过进一步的心理学测试来对肝性脑病进行筛查,并采取更积极的措施来处理便秘及其他易导致肝性脑病的因素。
