| ObjectivesPortal hypertension(PHT)is one of the main complications of liver cirrhosis(LC),clinically characterized by ascites,gastroesophageal varices(GOV),esophagogastric variceal bleeding(EVB),splenomegaly,hepatorenal syndrome,hepatopulmonary syndrome,and other related conditions.It is an important pathophysiological link that drives liver function decline after etiology and one of the main causes of death in liver cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is a minimally invasive interventional technique for the treatment of complications related to portal hypertension,which significantly reduces portal vein resistance by establishing a shunt channel in the liver parenchyma between the hepatic vein and the portal vein through the jugular vein.TIPS has achieved good therapeutic effects in the treatment of esophagogastric variceal bleeding,refractory ascites,hepatorenal syndrome,Budd-Chiari syndrome,portal vein thrombosis,and other diseases.However,the impact of TIPS treatment on liver function,the occurrence and influencing factors of hepatic encephalopathy(HE)after TIPS treatment,and the occurrence and influencing factors of rebleeding after TIPS treatment are still not fully understood.The aim of this study is to investigate the dynamic changes in liver function after TIPS treatment,the occurrence and influencing factors of HE after TIPS treatment,and the occurrence and influencing factors of rebleeding after TIPS treatment.MethodsThis study is a retrospective analysis of clinical data from a long-term management queue of patients with liver cirrhosis and portal hypertension who received TIPS treatment during January 2014 to December 2020 at the Shandong Public Health Clinical Center(formerly Jinan Infectious Disease Hospital).Based on inclusion and exclusion criteria,baseline data were collected for patients who met the criteria,including demographic information,clinical manifestations,laboratory,and imaging examination results,as well as clinical data on the occurrence of hepatic encephalopathy,rebleeding,and death at 1 month,3 months,6 months,and 1 year after TIPS treatment.The dynamic changes in liver function after TIPS treatment,the occurrence of HE after TIPS treatment and its influencing factors,and the occurrence of rebleeding after TIPS treatment and its influencing factors were analyzed.SPSS 25.0 software was used for statistical analysis.Normally distributed measurement data were described using mean± standard deviation,and non-normally distributed measurement data were described using median and quartile range M(P25,P75),while count data were described using frequency and frequency percentage n(n%).The t-test and Mann-Whitney U test were used to compare the two groups for normally and non-normally distributed measurement data,respectively,and the chi-square test was used to compare count data.Logistic regression analysis was used for multifactor analysis.Repeated measures ANOVA was used to compare the examination results at different time points.A p-value less than 0.05 was considered statistically significant.Results1.Baseline Characteristics of Patients Treated with TIPSA total of 283 eligible patients were included in this study.Among them,214(75.6%)were male,with a mean age of 52.4±10.2 years.The etiology of liver cirrhosis was HBV infection in 222 cases(78.4%),HCV infection in 7 cases(2.5%),alcohol-related in 26 cases(9.2%),autoimmune liver disease in 8 cases(2.8%),drug-induced liver injury in 1 case(0.4%),and unknown in 19 cases(6.7%).The Child-Pugh classification of the patients was A in 54 cases(19.1%),B in 166 cases(58.7%),and C in 63 cases(22.3%).The mean MELD score was 8.49± 5.28 points,and 262 cases(92.6%)had a MELD score ≤15 points.Among the 283 patients,180(63.6%)underwent TIPS for bleeding caused by esophagogastric varices rupture,76(26.9%)for refractory ascites,and 27(9.5%)for other reasons.The median portal venous pressure before TIPS was 39 cmH2O,which decreased to 25.5 cmH2O after TIPS,with a median decrease of 13 cmH2O.Within one year after TIPS treatment,10 patients(3.5%)died,with causes of death including variceal bleeding,liver cancer bleeding,hemorrhagic anemia,subacute liver failure,hepatic coma,acute heart failure,and ventricular fibrillation2.Dynamic Changes in Liver Function Before and After TIPS TreatmentThis study analyzed the results of liver function laboratory tests before TIPS treatment,as well as 1 week,1 month,3 months,and 6 months after treatment.The levels of alanine aminotransferase transaminase(ALT),total bilirubin(TBIL),and international normalized ratio(INR)increased at the 1-week follow-up after treatment and then gradually decreased and stabilized.On the other hand,the levels of albumin(ALB),platelet(PLT),and serum creatinine(Scr)decreased at the 1-week follow-up and then gradually increased and stabilized.However,no statistically significant differences were found in the dynamic changes of the Model for End-Stage Liver Disease(MELD)score after TIPS treatment.The values of relevant laboratory tests before TIPS treatment were as follows:ALT 30.4±25 U/L,TBIL 30.7±25.2 μmol/L,and ALB 31.9±7.2 g/L;INR 1.5±0.2,PLT 82.4±50.3×109/L,Scr 64.4± 13.4 μmol/L,and MELD 9.2±4.4 points.The values at 1 week after treatment were as follows:ALT 137.8±248.8 U/L,TBIL 45.4±39.6 μmol/L,ALB 30.8±7.2 g/L,INR 1.8±0.2,PLT 52.3± 13.4×109/L,Scr 55.6±8.7 μmol/L,and MELD 10.4±5,1 points.The values at 6 months after treatment were as follows:ALT 35.7±52.5 U/L,TBIL 50.9±41.6 μmol/L,ALB 30.9±6.2 g/L,INR 1.5±0.3,PLT 587.7±56.9×109/L,Scr 64.6± 17 μmol/L,and MELD 9.9±5 points3.Incidence and Risk Factors of HE within 1 Year after TIPS TreatmentOut of 283 patients,81(28.6%)developed HE within 1 year after TIPS treatment.Among them,64 cases(79%)occurred within 90 days after treatment,and 30 cases(37%)were induced by triggers,with high-protein diet being the cause in 21 cases(25.9%).The factors influencing the occurrence of HE within 1 year after TIPS treatment were:age:55.72±10.67 vs.51.02±9.71,P<0.001;gender:male(31.7%)vs.female(18.8%),P=0.039;baseline high bilirubin level:28.00(17.70,37.50)μmol/L vs.23.00(15.50,32.90)μmol/L,P=0.041.Age>50 years(OR=2.61,95%CI 1.47-4.65,P=0.001)and male gender(OR=2.66,95%CI 1.33-5.32,P=0.006)were independent risk factors for the occurrence of HE within 1 year after TIPS treatment.4.Incidence and Risk Factors of Rebleeding within 1 Year after TIPS TreatmentOut of 180 patients who underwent TIPS treatment for esophagogastric variceal bleeding,36 cases(20%)experienced rebleeding within 1 year after treatment,with 10 cases(28%)occurring within 6 weeks after treatment.Among the 36 cases of rebleeding,13 had clear triggers,including 6 cases of eating hard and fibrous food,4 cases of excessive physical exertion,and 3 cases of heavy drinking.The risk factors for rebleeding within 1 year after TIPS treatment were:age 48.54±8.60 vs.53.00±10.43,P=0.027;preoperative high serum creatinine level 70.55(59.55,77.00)μmol/L vs.61(54.98,68.93)μmol/L,P=0.003;baseline high blood phosphate level:1.08(0.89,1.37)μmol/L vs.1.02(0.80,1.17)μmol/L,P=0.026.Age≤50 years(OR=2.24,95%CI 1.04-4.80,P=0.038)and Scr>62μmol/L(OR=2.81,95%CI 1.25-6.31,P=0.012)were independent risk factors for rebleeding within 1 year after TIPS treatment.ConclusionsTIPS treatment can effectively reduce the portal vein pressure in patients with hepatic portal hypertension.Patients may experience transient liver dysfunction after TIPS treatment,and most patients’ liver function can gradually recover within 6 months.Within 1 year of TIPS treatment,28.6%of patients experienced hepatic encephalopathy,and the independent risk factors were age>50 years and male gender.Within 1 year of TIPS treatment,20%of patients experienced re-bleeding,and the independent risk factors were age ≤50 years and preoperative Scr>62μmol/L. |
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