失代偿期肝硬化TIPS术后轻微型肝性脑病的中医证型及危险因素分析

Analysis of Traditional Chinese Medicine Syndromes and Risk Factors of Minimal Hepatic Encephalopathy after TIPS in Decompensated Cirrhosis

目的探析失代偿期肝硬化行经颈静脉肝内门体静脉分流术(Transjugular Intrahepatic Portosystemic Shunt,TIPS)术后轻微型肝性脑病(Minimal Hepatic Encephopathy,MHE)的危险因素。方法回顾性选取2022年7月—2024年3月间福建医科大学孟超肝胆医院收治的70例失代偿期肝硬化行TIPS术的患者的临床资料,收集其性别、年龄、脾切除术史、是否合并腹水、Child-Pugh评分、糖尿病史、高血压史以及营养风险等信息,分析MHE发病率以及危险因素。结果经数字连接试验及数字符号试验测定,70例患者中27例发生MHE,MHE发病率为38.57%。在有无脾切除术史、有无合并腹水、Child-Pugh评分、有无营养风险方面,MHE组和非MHE组组间对比,差异有统计学意义(P均<0.05)。多因素Logistic回归分析显示,有脾切除术史、合并腹水、Child-Pugh评分B或C级以及有营养风险是失代偿期肝硬化患者TIPS术后MHE的相关发病危险因素(OR=1.088、1.107、3.121、1.007,P均<0.05)。结论失代偿期肝硬化TIPS术后轻微型肝性脑病发病率较高,有脾切除术史、有合并腹水、Child-Pugh评分B或C级以及有营养风险是MHE的发病危险因素。

Objective To explore the risk factors of minimal hepatic encephalopathy(MHE)after decompensate cirrhosis transjugular intrahepatic portosystemic shunt(TIPS)surgery.Methods The clinical data of 70 patients with decompensated cirrhosis who underwent TIPS in Mengchao Hepatobiliary Hospital of Fujian Medical University from July 2022 to March 2024 were retrospectively selected.Their gender,age,history of splenectomy,ascites,Child-Pugh score,history of diabetes,history of hypertension and nutritional risk were collected to analyze the incidence and risk factors of MHE.Results According to Number Connection Test-A and Digit Symbol Test,27 of 70 patients had MHE,and the incidence of MHE was 38.57%.There were significant differences between the MHE group and the non-MHE group in the history of splenectomy,ascites,Child-Pugh score and nutritional risk(all P<0.05).Multivariate Logistic regression analysis showed that the history of splenectomy,ascites,Child-Pugh score B or C and nutritional risk were risk factors for MHE after TIPS in patients with decompensated cirrhosis(OR=1.088,1.107,3.121,1.007,all P<0.05).Conclusion The incidence of minimal hepatic encephalopathy after TIPS in decompensated cirrhosis is high.History of splenectomy,ascites,Child-Pugh score B or C and nutritional risk are risk factors for MHE.