Study On Hemodynamic Changes And Hepatic Encephalopathy And Stent Dysfunction After Transjugular Intrahepatic Portal Shunt

Objective: This paper aims to investigate clinical value of intrahepatic and intra-stent hemodynamic changes after transjugular intrahepatic portosystemic shunt（TIPS）,by using color Doppler ultrasound during the diagnosis of hepatic encephalopathy（HE）in the patients with hepatitis B cirrhosis.Methods: A retrospective analysis of the patients with hepatitis B cirrhotic portal hypertension,who underwent TIPS in The First Affiliated Hospital of Anhui Medical University from January 2018 to January 2021,was conducted.22 patients who developed HE within 3 months after TIPS comprised the observation group（HE group）,and 51 patients who did not develop HE were randomly selected as the control group（non-HE group）.All patients underwent routine blood tests of liver and kidney function blood ammonia and routine color Doppler ultrasonography before and after TIPS within 48 hours.The porto systemic gradient（PSG）,as well as intrahepatic and intra-stent hemodynamic changes of patients in both HE group and non-HE group after TIPS were investigated.Results: The intra-stent blood flow,PSG difference,and PSG decrease percentage in the HE group were higher than those in the non-HE group,and the intra-stent flow had a weak positive correlation with PSG difference and with the PSG decrease percentage（r=0.420,0.258,respectively）.The areas under the ROC curves of HE based on the PSG difference,the PSG decrease percentage,and the intra-stent flow were 0.762,0.753,and 0.693,respectively.Conclusion: The more obvious decrease in PSG difference,the larger the intra-stent blood flow,and the larger the possibility of HE occurrence were observed.Routine ultrasound measurement of hemodynamic changes has certain clinical significance for predicting HE occurrence.Objective To investigate the predictive value of platelet volume distribution width（PDW）,mean platelet volume（MPV）,and D-dimer（D-D）on early shunt dysfunction in patients with decompensated cirrhosis treated with TIPS.Methods A total of 28 patients with decompensated cirrhosis who developed shunt dysfunction within 6 months after TIPS were selected as the case group,and a 1:2 matched control study was conducted.56 patients matched by age（±2）and gender who did not develop shunt dysfunction within 6 months after TIPS were selected as the control group.Spss23.00 software was used to conduct univariate analysis to obtain statistically significant variables,and then conditional Logistic regression analysis was conducted with paired design,with P<0.05 being statistically significant.Results: Patients with a history of splenectomy,portal vein thrombosis,and those with poor liver function grade were more likely to have functional dysfunction after TIPS.Platelet count（PLT）,platelet volume distribution width（PDW）,mean platelet volume（MPV）,D-dimer（D-D）and Fibrinogen monomer（FDPI）had statistically significant differences between the case group and the control group.The values of D-D、PDW、MPV and FDPI in the case group were higher than those in the control group,while the value of PLT in the case group was lower than that in the control group.The OR values of PDW,MPV and D-D were 2.164,3.826 and 1.382,respectively.ROC analysis results showed that the AUC of PDW,MPV and D-D were 0.746,0.773 and 0.690,respectively.Conclusion Compared with ultrasound,D-D,PLT,and PDW could predict shunt dysfunction earlier after TIPS.Patients with normal shunt function indicated by color Doppler ultrasonography in postoperative follow-up of TIPS should be closely observed for indicators such as D-D,PLT and PDW,which is of important significance for clinical indication of shunt dysfunction in TIPS.