Objective: To investigate the impact of a reduced portacaval shunt on hepatic myelopathy (HM) in patients with cirrhosis after a transjugular intrahepatic portosystemic shunt (TIPS). Methods: Patients who developed HM after receiving TIPS at the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to June 2018 were retrospectively analyzed. HM severity was quantified by clinical spasticity index (CSI) and Fugl-Meyer Assessment (FMA) of the lower extremity. Clinical manifestations were combined with grades Ⅰ-Ⅳ. HM patients were divided into drug treatment (group A) and flow restriction group (group B) according to different treatment methods. The changes in CSI and FMA of the lower extremity after treatment were statistically analyzed in the two groups. P<0.05 was considered a statistically significant difference. Results: A total of 421 cases of cirrhosis who underwent TIPS were enrolled. Among them, 30 developed HM, with 22 in group A and 8 in group B. The incidence of HM after TIPS surgery was about 7.13%. After treatment, CSI was gradually increased and FMA of lower extremity was gradually decreased in group A, while vice-versa in group B. CSI in the two groups were differed significantly at 6, 12, 18, and 24 months after treatment (P<0.05), while the difference in FMA of the lower extremity was statistically significant at 12, 18, and 24 months after treatment (P<0.05). CSI was decreased and FMA of lower extremity was increased after treatment in patients with group A HM grade I. CSI, and FMA of lower extremity changes were statistically significant (P<0.05) when compared with patients with HM grades Ⅱ-Ⅳ. The incidence of hepatic encephalopathy was significantly lower in group B than that in group A (P=0.034), but there was no statistically significant difference between the two groups in the incidence of gastrointestinal bleeding, ascites, infection, MELD score and mortality. Conclusion: A reduced portacaval shunt can improve HM in patients with liver cirrhosis after TIPS, and drug therapy alone is effective for patients with early HM grade I.
目的： 探究减少门腔分流量对肝硬化患者经颈静脉肝内门体分流术（TIPS）后肝性脊髓病（HM）的影响。 方法： 回顾性分析2013年1月至2018年6月于西安交通大学第一附属医院接受TIPS治疗后发生HM的患者资料。采用临床痉挛指数（CSI）及下肢Fugl-Meyer运动功能评分（FMA）对HM的严重程度进行量化，并结合临床表现，将其分为I～IV级；将HM患者按治疗方法的不同分为药物治疗组（A组）与限流组（B组），对两组患者在治疗后CSI及下肢FMA的变化进行统计分析，计量资料若满足正态分布采用t检验，若不满足正态分布则采用秩和检验；计数资料采用卡方检验（χ2检验），若样本量不足40例，或有期望频数小于1，则采用Fisher确切检验；等级资料采用秩和检验。 结果： 共纳入421例接受TIPS术的肝硬化患者，30例发生HM，A组22例，B组8例。TIPS术后HM的发病率约为7.13%。A组患者在治疗后，CSI逐渐上升，下肢FMA逐渐下降，B组则反之；两组患者CSI在治疗后6、12、18、24个月之间的差异有统计学意义（P<0.05），下肢FMA在治疗后12、18、24个月之间的差异有统计学意义（P<0.05）。A组患者中，HM I级患者在治疗后CSI下降，下肢FMA升高，与II～IV级患者相比，CSI及下肢FMA的变化差异有统计学意义（P<0.05）。B组患者肝性脑病发生率明显低于A组患者（P=0.034），但两组患者在消化道出血、腹水、感染等发生率，以及MELD评分及死亡率之间的差异无统计学意义。 结论： 减少门腔分流量能够改善肝硬化患者TIPS术后HM，单纯药物治疗对HM早期（I期）患者有效。.