经颈静脉肝内门体分流术后肝性脑病的研究现状

陈功海; 王广川; 张春清

doi:10.3969/j.issn.1001-5256.2021.05.047

经颈静脉肝内门体分流术后肝性脑病的研究现状

DOI: 10.3969/j.issn.1001-5256.2021.05.047

陈功海¹,
王广川²,
张春清^{1, 2, ,}

1.
山东大学附属省立医院消化内科，济南 250021
2.
山东第一医科大学附属省立医院消化内科，济南 250021

基金项目:

济南市临床医学科技创新计划项目 (201805069);

国家自然科学基金项目 (81770606)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明： 陈功海负责查阅国内外文献并撰写论文；王广川负责论文的审校；张春清负责指导论文撰写、审校并最后定稿。

详细信息

作者简介:
陈功海(1994—)，男，主要从事门静脉高压症及其并发症的防治研究

通信作者:
张春清，13583188661@163.com

中图分类号: R575
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- 文章访问数: 558
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- PDF下载量: 55
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-30
- 录用日期: 2020-12-15
- 出版日期: 2021-05-20

Current status of research on hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

1.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
2.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China

摘要

摘要: 肝性脑病是经颈静脉肝内门体分流术(TIPS)后常见的并发症，目前尚无系统的防治策略。在近些年国内外相关研究的基础上，重点分析并总结了TIPS术后肝性脑病的危险因素及防治进展, 提出未来研究应注重隐性肝性脑病的早期诊断和预防，规范TIPS术后肝性脑病的预防策略。
- 门体分流术，经颈静脉肝内 /
- 肝性脑病 /
- 危险因素 /
- 治疗学 /
- 预防
Abstract: Hepatic encephalopathy (HE) is a common complication after transjugular intrahepatic portosystemic shunt (TIPS), and there are still no systematic strategies for prevention and treatment at present. Based on recent studies in China and foreign countries, this article analyzes and summarizes the risk factors for HE after TIPS and the advances in treatment and prevention. It is pointed out that early diagnosis and prevention of covert HE should be emphasized in further research, and it is important to standardize the prevention strategies for HE after TIPS.
- Portasystemic Shunt, Transjugular Intrahepatic /
- Hepatic Encephalopathy /
- Risk Factors /
- Therapeutics /
- Prevention

HTML全文

表 1 有关TIPS术后HE危险因素的研究总结

作者	时间(年)	独立危险因素
Li Y等^[3]	2019	年龄、Child-Pugh评分、纤维蛋白原
Nardelli S等^[8]	2016	既往HE病史、年龄、低门体静脉压力梯度、高Child-Pugh评分、血肌酐升高及低血钠
Zivony AS等^[15]	2014	PSG下降≥60%
Bai M等^[16]	2011	年龄＞65岁、HE病史以及Child-Pugh评分＞10
Yin X等^[17]	2019	糖尿病、年龄
Nardelli S等^[18]	2017	MELD评分、肌少症
Rowley MW等^[19]	2018	支架直径＞8 mm、既往HE病史、血清白蛋白≤ 2.5 g/dl
Fonio P等^[20]	2017	年龄＞60岁
Casadaban LC等^[21]	2015	MELD评分、年龄≥65岁
Routhu M等^[22]	2017	年龄、术前门静脉压力、血肌酐、糖尿病
Lewis DS等^[23]	2019	年龄大、男性、MELD评分高、HE病史、HE预防用药史、PPI治疗(与剂量呈正相关)
Sturm L等^[24]	2018	PPI治疗(与剂量呈正相关)
注：PSG，门体循环压力梯度；PPI，质子泵抑制剂。

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参考文献(35)

[1]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007. 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007.
[2]	PATIDAR KR, BAJAJ JS. Covert and overt hepatic encephalopathy: Diagnosis and management[J]. Clin Gastroenterol Hepatol, 2015, 13(12): 2048-2061. DOI: 10.1016/j.cgh.2015.06.039.
[3]	LI Y, HE X, PANG H. A model to predict early hepatic encephalopathy in patients undergoing transjugular intrahepatic portosystemic shunt[J]. Turk J Gastroenterol, 2019, 30(8): 702-707. DOI: 10.5152/tjg.2019.18485.
[4]	BETTINGER D, SCHULTHEISS M, BOETTLER T, et al. Procedural and shunt-related complications and mortality of the transjugular intrahepatic portosystemic shunt (TIPSS)[J]. Aliment Pharmacol Ther, 2016, 44(10): 1051-1061. DOI: 10.1111/apt.13809.
[5]	PERARNAU JM, LE GOUGE A, NICOLAS C, et al. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: A randomized controlled trial[J]. J Hepatol, 2014, 60(5): 962-968. DOI: 10.1016/j.jhep.2014.01.015.
[6]	BUREAU C, GARCIA-PAGAN JC, OTAL P, et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: Results of a randomized study[J]. Gastroenterology, 2004, 126(2): 469-475. DOI: 10.1053/j.gastro.2003.11.016.
[7]	VILSTRUP H, AMODIO P, BAJAJ J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60(2): 715-735. DOI: 10.1002/hep.27210.
[8]	NARDELLI S, GIOIA S, PASQUALE C, et al. Cognitive impairment predicts the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J]. Am J Gastroenterol, 2016, 111(4): 523-528. DOI: 10.1038/ajg.2016.29.
[9]	SAID VJ, GARCIA-TRUJILLO E. Beyond lactulose: Treatment options for hepatic encephalopathy[J]. Gastroenterol Nurs, 2019, 42(3): 277-285. DOI: 10.1097/SGA.0000000000000376.
[10]	LUO M, LI L, YANG EN, et al. Correlation between interleukin-6 and ammonia in patients with overt hepatic encephalopathy due to cirrhosis[J]. Clin Res Hepatol Gastroenterol, 2013, 37(4): 384-390. DOI: 10.1016/j.clinre.2012.08.007.
[11]	SURAWEERA D, SUNDARAM V, SAAB S. Evaluation and management of hepatic encephalopathy: Current status and future directions[J]. Gut Liver, 2016, 10(4): 509-519. DOI: 10.5009/gnl15419.
[12]	SFARTI C, CIOBICA A, BALMUS IM, et al. Systemic oxidative stress markers in cirrhotic patients with hepatic encephalopathy: Possible connections with systemic ammoniemia[J]. Medicina (Kaunas), 2020, 56(4): 196. DOI: 10.3390/medicina56040196.
[13]	JI XT, HE YH, QI YY, et al. Mechanism of action of intestinal flora in hepatic encephalopathy[J]. J Clin Hepatol, 2020, 36(3): 690-692. DOI: 10.3969/j.issn.1001-5256.2020.03.049. 姬晓彤, 贺韵涵, 戚莹媛, 等. 肠道菌群在肝性脑病中的作用机制[J]. 临床肝胆病杂志, 2020, 36(3): 690-692. DOI: 10.3969/j.issn.1001-5256.2020.03.049.
[14]	RIDOLA L, RIGGIO O, GIOIA S, et al. Clinical management of type C hepatic encephalopathy[J]. United European Gastroenterol J, 2020, 8(5): 536-543. DOI: 10.1177/2050640620909675.
[15]	ZIVONY AS, CHEN L, KAUFMAN J, et al. The degree in reduction of portal-systemic gradient during tips and not final post-tips portal pressure gradient is predictive of the development of hepatic encephalopathy[J]. Gastroenterology, 2014, 146(5): S-932.
[16]	BAI M, QI X, YANG Z, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: A systematic review[J]. J Gastroenterol Hepatol, 2011, 26(6): 943-951. DOI: 10.1111/j.1440-1746.2011.06663.x.
[17]	YIN X, ZHANG F, XIAO J, et al. Diabetes mellitus increases the risk of hepatic encephalopathy after a transjugular intrahepatic portosystemic shunt in cirrhotic patients[J]. Eur J Gastroenterol Hepatol, 2019, 31(10): 1264-1269. DOI: 10.1097/MEG.0000000000001452.
[18]	NARDELLI S, LATTANZI B, TORRISI S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement[J]. Clin Gastroenterol Hepatol, 2017, 15(6): 934-936. DOI: 10.1016/j.cgh.2016.10.028.
[19]	ROWLEY MW, CHOI M, CHEN S, et al. Refractory hepatic encephalopathy after elective transjugular intrahepatic portosystemic shunt: Risk factors and outcomes with revision[J]. Cardiovasc Intervent Radiol, 2018, 41(11): 1765-1772. DOI: 10.1007/s00270-018-1992-2.
[20]	FONIO P, DISCALZI A, CALANDRI M, et al. Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) according to its severity and temporal grading classification[J]. Radiol Med, 2017, 122(9): 713-721. DOI: 10.1007/s11547-017-0770-6.
[21]	CASADABAN LC, PARVINIAN A, MINOCHA J, et al. Clearing the confusion over hepatic encephalopathy after TIPS creation: Incidence, prognostic factors, and clinical outcomes[J]. Dig Dis Sci, 2015, 60(4): 1059-1066. DOI: 10.1007/s10620-014-3391-0.
[22]	ROUTHU M, SAFKA V, ROUTHU SK, et al. Observational cohort study of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS)[J]. Ann Hepatol, 2017, 16(1): 140-148. DOI: 10.5604/16652681.1226932.
[23]	LEWIS DS, LEE TH, KONANUR M, et al. Proton pump inhibitor use is associated with an increased frequency of new or worsening hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation[J]. J Vasc Interv Radiol, 2019, 30(2): 163-169. DOI: 10.1016/j.jvir.2018.10.015.
[24]	STURM L, BETTINGER D, GIESLER M, et al. Treatment with proton pump inhibitors increases the risk for development of hepatic encephalopathy after implantation of transjugular intrahepatic portosystemic shunt (TIPS)[J]. United European Gastroenterol J, 2018, 6(9): 1380-1390. DOI: 10.1177/2050640618795928.
[25]	PEREIRA K, CARRION AF, SALSAMENDI J, et al. Endovascular management of refractory hepatic encephalopathy complication of transjugular intrahepatic portosystemic shunt (TIPS): Comprehensive review and clinical practice algorithm[J]. Cardiovasc Intervent Radiol, 2016, 39(2): 170-182. DOI: 10.1007/s00270-015-1197-x.
[26]	LUO L, FU S, ZHANG Y, et al. Early diet intervention to reduce the incidence of hepatic encephalopathy in cirrhosis patients: Post-transjugular intrahepatic portosystemic shunt (TIPS) findings[J]. Asia Pac J Clin Nutr, 2016, 25(3): 497-503. DOI: 10.6133/apjcn.092015.14.
[27]	SHARMA BC, SHARMA P, LUNIA MK, et al. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy[J]. Am J Gastroenterol, 2013, 108(9): 1458-1463. DOI: 10.1038/ajg.2013.219.
[28]	BAI M, YANG Z, QI X, et al. l-ornithine-l-aspartate for hepatic encephalopathy in patients with cirrhosis: A meta-analysis of randomized controlled trials[J]. J Gastroenterol Hepatol, 2013, 28(5): 783-792. DOI: 10.1111/jgh.12142.
[29]	PEREIRA K, CARRION AF, MARTIN P, et al. Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy[J]. Liver Int, 2015, 35(12): 2487-2494. DOI: 10.1111/liv.12956.
[30]	ZHAO YJ, HAN GH, YIN ZX, et al. Clinical analysis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS)[J]. Contemporary Medicine, 2010, 16(11): 139-141. DOI: 10.3969/j.issn.1009-4393.2010.11.004. 赵延军, 韩国宏, 殷占新, 等. 经颈静脉肝内门体分流(TIPS)术后并发肝性脑病的临床分析[J]. 当代医学, 2010, 16(11): 139-141. DOI: 10.3969/j.issn.1009-4393.2010.11.004.
[31]	WANG Q, LV Y, BAI M, et al. Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding[J]. J Hepatol, 2017, 67(3): 508-516. DOI: 10.1016/j.jhep.2017.05.006.
[32]	SCHEPIS F, VIZZUTTI F, GARCIA-TSAO G, et al. Under-dilated TIPS associate with efficacy and reduced encephalopathy in a prospective, non-randomized study of patients with cirrhosis[J]. Clin Gastroenterol Hepatol, 2018, 16(7): 1153-1162. e7. DOI: 10.1016/j.cgh.2018.01.029.
[33]	LUO SH, CHU JG, HUANG H, et al. Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy[J]. World J Gastroenterol, 2019, 25(9): 1088-1099. DOI: 10.3748/wjg.v25.i9.1088.
[34]	CHUNG HH, RAZAVI MK, SZE DY, et al. Portosystemic pressure gradient during transjugular intrahepatic portosystemic shunt with Viatorr stent graft: What is the critical low threshold to avoid medically uncontrolled low pressure gradient related complications?[J]. J Gastroenterol Hepatol, 2008, 23(1): 95-101. DOI: 10.1111/j.1440-1746.2006.04697.x.
[35]	SHI Y, TIAN X, HU J, et al. Efficacy of transjugular intrahepatic portosystemic shunt with adjunctive embolotherapy with cyanoacrylate for esophageal variceal bleeding[J]. Dig Dis Sci, 2014, 59(9): 2325-2332. DOI: 10.1007/s10620-014-3150-2.