Evaluation of mid- and long-term efficacy of shunt limiting for hepatic myelopathy after transjugular intrahepatic portosystemic shunt

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• 作者：Hongwei Zhao ; Fuquan Liu ; ^{hongweizhao2014@163.com" class="auth_mail" title="E-mail the corresponding author} ; Zhendong Yue ; Lei Wang ; Zhenhua Fan
• 刊名：Clinics and Research in Hepatology and Gastroenterology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：40
• 期：4
• 页码：440-446
• 全文大小：960 K

文摘

Hepatic myelopathy (HM) is a rare condition caused by severe liver dysfunction, and may be secondary to transjugular intrahepatic portosystemic shunt (TIPS). This study aimed to evaluate the mid- and long-term clinical efficacy of TIPS reduction (TIPSR) for treatment of HM secondary to TIPS.

Methods

Patients who underwent TIPS (n = 1325) for severe portal hypertension between August 2002 and August 2013 at the Affiliated Beijing Millennium Monument Hospital, Capital Medical University (Beijing, China) were reviewed. During follow-up, 22 patients were diagnosed with HM, and 12 underwent TIPSR. Patients were evaluated using the Barthel index (daily activities), the Lovette's Six Classification (lower extremity muscle strength), and the Fugl-Meyer assessment (FMA; lower extremity activity). Hepatic encephalopathy grade was used to assess the severity of clinical symptoms.

Results

TIPSR did not affect portal vein pressure (31.6 ± 6.2 vs. 33.3 ± 7.9 mmHg, P = 0.55). Blood ammonia levels were 77.9 ± 17.9 mmol/L before TIPSR and 77.9 ± 14.8, 73.5 ± 21.5, 59.5 ± 14.5, and 52.0 ± 16.5 mmol/L at 1, 3, 6, and 12 months (P < 0.05 for 6 and 12 months vs. baseline). The Barthel index was improved 6 months after TIPSR (42.1 ± 10.5 vs. 45.0 ± 8.8, P < 0.05), while FMA was improved 3 months after TIPSR only (24.6 ± 3.2 vs. 25.5 ± 3.2, P < 0.05). Lovette's Six Classification was improved 12 months after TIPSR (2.1 ± 0.7 vs. 2.8 ± 0.9, P < 0.05). After TIPS, hepatic encephalopathy grade was I (n = 3), II (n = 6), III (n = 2), or IV (n = 1), and was I (n = 8), II (n = 1), or III (n = 1) at 6 months.

Conclusion

TIPSR can improve the mid- and long-term symptoms of HM secondary to TIPS.