Analysis Of Risk Factors And Clinical Features Of Decompensated Liver Cirrhosis Complicated With Hepatic Myelopathy

BackgroundLiver cirrhosis is a common disease of the digestive system,which is mainly due to the chronic progressive destruction and regeneration of hepatocytes in the liver,which leads to diffuse fibrosis in the liver.When chronic liver disease develops to the stage of liver cirrhosis,it usually leads to the destruction of liver structure and the formation of extensive cirrhotic nodules.According to the progress of liver cirrhosis,it can be divided into compensated cirrhosis and decompensated cirrhosis.The decompensated stage of liver cirrhosis is usually complicated with common complications such as gastrointestinal bleeding,peritoneal effusion,hepatic encephalopathy,hepatorenal syndrome and so on.Hepatic myelopathy is a rare complication in the decompensated stage of liver cirrhosis.The typical clinical manifestation is chronic progressive spastic paraplegia of both lower extremities.Compared with hepatic encephalopathy,hepatic myelopathy is usually difficult to reverse and the prognosis is usually poor.At present,there is no specific treatment for hepatic myelopathy.Early detection and early liver transplantation may be the only effective measure to prevent the disease from progressing.ObjectiveThe purpose of this study is to explore the related risk factors and clinical characteristics of decompensated liver cirrhosis complicated with hepatic myelopathy,so as to provide some reference value for early detection,early prevention and early intervention of hepatic myelopathy.MethodsA total of 51 patients diagnosed with decompensated liver cirrhosis complicated with hepatic myelopathy and 91 patients with matching age and sex during the same period diagnosed with decompensated liver cirrhosis without hepatic myelopathy were selected into the observation and control groups,respectively,from the first affiliated Hospital of Zhengzhou University between January 2014 and June 2020.The etiology,clinical symptoms and signs,results of auxiliary examination,treatment and prognosis of decompensated liver cirrhosis complicated with hepatic myelopathy were analyzed retrospectively.At the same time,the clinical data and clinical characteristics of the patients in the observation group and the control group were compared.The risk factors of decompensated liver cirrhosis complicated with hepatic myelopathy were screened by univariate analysis and multivariate Logistic regression analysis.Results1.Univariate analysis of patients in the observation group and control group showed that male,high blood ammonia,splenectomy,TIPS,history of hepatic encephalopathy,low albumin and decreased prothrombin activity were risk factors for decompensated liver cirrhosis complicated with hepatic myelopathy.(P<0.05).2.After univariate analysis,the statistically significant factors were selected and included in the multivariate binary logistics regression analysis model.The results suggest that high blood ammonia and TIPS surgery are independent risk factors for decompensated liver cirrhosis complicated with hepatic myelopathy.(P<0.05).3.The incidence of hepatic myelopathy is mainly male,with a male-female ratio of 7.5:1,and the average age was 50.55±9.876 years old.The main causes are viral cirrhosis,including hepatitis B cirrhosis(64.71%),hepatitis C cirrhosis(9.80%),alcoholic cirrhosis(5.88%),autoimmune cirrhosis(1.96%),Budd-Chiari syndrome(1.96%)and cirrhosis caused by other unknown causes(15.69%).The clinical manifestations mainly include the decompensated phase of liver cirrhosis and myelopathy.Cranial MRI examination showed high signal intensity on T1WI and T2WI in bilateral basal ganglia.MRI examination of spinal cord showed long T2 signal changes in thoracic spinal cord,inhomogeneous signal intensity in cervical spinal cord and high signal intensity in fat compression sequence.No obvious abnormality was found in EEG and cerebrospinal fluid examination.The motor evoked potential can indicate that the pyramidal tract conduction of both lower extremities is not elicited,and the somatosensory evoked potential can indicate the delay of deep sensory pathway conduction of both lower extremities.At present,there is still no specific treatment for hepatic myelopathy,which is mainly aimed at the basic medical treatment of the primary disease and promoting the recovery of spinal cord function,but the effect is usually poor.Early detection,early diagnosis and early liver transplantation may be the only effective measures to prevent the progression of hepatic myelopathy and improve the prognosis of patients.Conclusions1.High blood ammonia and TIPS are independent risk factors of decompensated liver cirrhosis complicated with hepatic myelopathy,which suggests that patients with recurrent high blood ammonia and TIPS should be vigilant and pay attention to the possibility of developing into hepatic myelopathy.2.Imaging of the head and spinal cord usually lacks specificity.EMG examination can show damage to upper motor neurons.Motor evoked potentials can detect conduction abnormalities in the central nervous system early.Imaging,electromyography and motor evoked potential examination can provide certain reference value for the diagnosis of hepatic myelopathy as an auxiliary means for early detection of hepatic myelopathy.3.Hepatic myelopathy usually develops slowly and has a poor prognosis,and the damage caused by it is often irreversible.At present,there is still no clear and effective treatment for hepatic myelopathy,and the clinical treatment is mainly aimed at the basic medical treatment of the primary disease and promoting the recovery of spinal cord function.Early liver transplantation may be the only effective way to treat the disease at its root.Early detection,early diagnosis and early treatment are of great significance to improve the prognosis of patients with hepatic myelopathy.