经颈静脉肝内门体分流术后显性肝性脑病发生率及危险因素分析

Incidence and Risk Factors of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt

目的探究经颈静脉肝内门体静脉分流术(TIPS)后显性肝性脑病(OHE)的发生率并分析相关危险因素。方法回顾性分析接受TIPS术治疗的263例肝硬化患者的临床资料。搜集患者基线资料,统计术后3个月OHE发生情况,筛选出与TIPS术后OHE发生密切相关的因素,获取有统计学意义的变量,进行二元Logistic回归分析,构建受试者特征曲线,建立TIPS术后OHE发生的预测模型。结果术后OHE的发生率为22.1%(58/263)。OHE组和无OHE组在年龄、糖尿病史、乙肝病史、TBIL、INR、PT、血氨、门静脉流速、Child-Pugh评分、Child-Pugh分级、MELD评分、MELD-Na+评分、术后门静脉压力比较,差异有统计学意义(P<0.05)。年龄、糖尿病史、乙肝病史、血氨、Child-Pugh分级为TIPS术后OHE发生的独立危险因素(P<0.05)。联合年龄、糖尿病史、乙肝病史、血氨、Child-Pugh分级构建的临床预测模型曲线下面积为0.841。结论TIPS术后OHE发生的独立危险因素为年龄、糖尿病史、乙肝病史、血氨和Child-Pugh分级。基于Logistic回归分析构建临床预测模型可进行个体化预测,实现临床获益最大化。

Objective To explore the incidence and risk factors of overt hepatic encephalopathy(OHE)after transjugular intrahepatic portosystemic shunt(TIPS).Methods The clinical data of 263 patients with liver cirrhosis who underwent TIPS were retrospectively analyzed.The baseline data of patients were collected,and the occurrence of overt hepatic encephalopathy at 3 months after operation was statistically analyzed.Factors closely related to the occurrence of OHE after TIPS were screened out,and statistically significant variables were obtained.Binary Logistic regression analysis was performed to construct the receiver characteristic curve,and a prediction model for the occurrence of OHE after TIPS was established.Results The incidence of postoperative OHE was 22.1%(58/263).There were significant differences in age,history of diabetes,history of hepatitis B,TBIL,INR,PT,blood ammonia,portal vein flow rate,Child-Pugh score,Child-Pugh grade,MELD score,MELD-NA+score,and postoperative portal vein pressure between the OHE group and the non-OHE group(P<0.05).Age,history of diabetes,history of hepatitis B,blood ammonia and Child-Pugh classification were independent risk factors for overt hepatic encephalopathy after TIPS(P<0.05).The area under the curve of the clinical prediction model combined with age,history of diabetes,history of hepatitis B,blood ammonia and Child-Pugh classification was O.841.Conclusion The independent risk factors of overt hepatic encephalopathy after TIPS are age,history of diabetes,history of hepatitis B,blood ammonia and Child-Pugh classification.The clinical prediction model based on Logistic regression analysis can be used for individualized prediction and maximize clinical benefit.