Hepatic myelopathy after transjugular intrahepatic portosystemic shunt: natural course, survival analysis, and treatment
10.3969/j.issn.1001-5256.2016.06.018
- VernacularTitle:经颈静脉肝内门体分流术后肝性脊髓病的临床特征分析
- Author:
Shuyao REN
1
;
Hui CHEN
;
Yong LYU
Author Information
1. Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi′an 710032, China
- Publication Type:Research Article
- Keywords:
liver cirrhosis;
hypertension, portal;
hepatic myelopathy;
portasystemic shunt, transjugular intrahepatic
- From:
Journal of Clinical Hepatology
2016;32(6):1112-1117
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo investigate the features of hepatic myelopathy (HM) after transjugular intrahepatic portosystemic shunt (TIPS). MethodsA retrospective analysis was performed for a consecutive cohort of patients with cirrhotic portal hypertension who were successfully treated with TIPS in Department of Liver Disease and Digestive Interventional Radiology in Xijing Hospital of Digestive Diseases, Fourth Military Medical University, from 2005 to 2014 and then developed HM. Routine follow-up was performed for all patients at 1, 3, and 6 months after TIPS and every half a year subsequently. The time to disease progression was used to summarize the natural course of HM, the comparison of continuous data was made by independent samples t-test, the comparison of categorical date was made by chi-square test. The Kaplan-Meier method was used for survival analysis, and the Cox proportional hazards regression model was used to determine prognostic factors. Relief of symptoms in the lower limbs was analyzed to investigate the therapeutic effect. ResultsThe time to HM progression from grade 1 to grades 2, 3, and 4 was 40 months (range, 1-36 months), 8.5 months (range, 1-44 months), and 18.8 months (range, 54-48.6 months), respectively. In HM patients, the 1-, 3-, and 5-year cumulative survival rates were 84.19%, 5186%, and 4521%, respectively. Age of HM onset (HR=1.034, 95% CI: 1.003-1.065) and recurrent ascites (HR=3.869, 95% Cl: 1623-9225) were independent prognostic factors in patients with HM. The patients who underwent liver transplantation had a significantly higher proportion of patients with relief of symptoms than those who did not undergo liver transplantation (χ2=13.5, P=0.003), while the effects of stent flow limitation and occlusion showed no significant differences (P＞0.05). ConclusionThe course of HM consists of rapid progression stage and plateau stage, and HM patients after TIPS show good survival. At present, liver transplantation is an effective method to treat HM.
