| Background and Aims: HBV infection is one of the leading cause of cirrhosis of the liver,with the progress of the cirrhosis,gradually appeared hepatic encephalopathy(HE),spontaneous bacterial peritonitis(SBP)and other serious complications.The purpose of this study is to analyze the related influencing factors and predictive factors of HE and SBP in patients with HBV related cirrhosis,and to provide new ideas for the prevention and treatment of complications of clinical cirrhosis.Methods: The total of 386 consecutive patients with HBV-related cirrhosis who were admitted to the First Hospital of Lanzhou University from July 1,2018 to September 19,2018 were strictly enrolled and regularly followed up.The end point of observation was the occurrence of HE or SBP.Serological data and imaging data of the included population were collected,and the results were analyzed by univariate,multivariate and receiver operating characteristic curves(ROC).Results: In the prospective study on the occurrence of HE,among 156 patients with HBV-related cirrhosis,six patients developed HE within 3 months,and the cumulative incidence rate was 3.85%.Compared with patients without HE,the portal vein diameter of patients with HE was significantly increased(P=0.026).Multivariate analysis showed that the portal vein diameter(P=0.030,OR=1.03)was independently correlated with the occurrence of HE in patients with HBV-related cirrhosis,and the area under the ROC curve(AUC)was 0.87.Seven patients developed HE within 6 months,the cumulative incidence was 4.49%.Compared with patients without HE,the height(P=0.045)and portal vein diameter(P=0.026)of patients with HE were significantly increased,and portal vein diameter(P=0.030,OR=1.39)was independently correlated with the occurrence of HE in patients with HBV-related cirrhosis,the AUC was 0.88.The cut-off values of portal vein diameter at 3 months and 6 months were 13.6 mm.Kaplan Meier survival analysis and log-rank test showed that there was a significant difference in the incidence of HE between the group with portal vein diameter < 13.6 mm and the group with portal vein diameter ≥13.6 mm.At the same time,in the cross-sectional study,the incidence of HE was 10.30%.Compared with patients without HE,AST / ALT(P=0.010),PVT(P=0.003)in patients with HE were significantly increased,HBC(P=0.002),HGB(P=0.016),ALT(P=0.010),ALP(P=0.018),TP(P=0.034),TC(P=0.039)were significantly decreased,and PVT(P=0.008,OR=4.07)was independently associated with the occurrence of HE in patients with HBV-related cirrhosis.In addition,among the 26 patients who underwent TIPS,seven patients had HE,with an incidence of 26.92%.Compared with patients who did not have HE,the incidence of PVT in patients with HE was significantly higher(P=0.028).PVT(P=0.048,OR=10.04)was also independently associated with the occurrence of HE in patients with HBV-related cirrhosis after TIPS.In the cross-sectional study of the occurrence of SBP,DBIL(P=0.029)and MELD score(P=0.030)of patients with SBP were significantly higher than those without SBP,while HBC(P=0.025),ALB(P=0.001),A/Q(P=0.004),CHE(P=0.000),portal vein diameter(P=0.018)and spleen thickness(P=0.012)were significantly lower.The above variables were significantly correlated with the occurrence of SBP(P <0.05).The above variables were divided into two aspects to enter the multi factor analysis,namely,indicators related to liver synthesis function and indicators related to liver injury.The results showed that CHE decreased(OR=1.47,95% CI: 0.23-0.96),portal vein diameter widened(OR=0.60,95% CI: 0.38-0.94)and MELD score increased(OR=1.57,95% CI:1.06-2.34)were independently associated with SBP in patients with HBV-related cirrhosis.Among them,73 patients had ascites.Compared with patients without SBP,WBC(P=0.001),CREA(P=0.002),MELD score(P=0.020)of patients with SBP were significantly increased,portal vein diameter(P=0.003)and spleen thickness(P=0.001)were significantly decreased,and the above variables were significantly correlated with the occurrence of SBP(P < 0.05).In addition,CREA increased,portal vein diameter widened,and MELD score increased(OR=1.04,OR=0.42,OR=1.52,95%CI: 1.01-1.08,95%CI: 0.29-0.89,95%CI: 0.99-2.31)was independently associated with the occurrence of SBP in patients with HBV-related cirrhosis with peritoneal effusion.Conclusion: The diameter of portal vein ≥ 13.6 mm was an independent predictor of HE within 3 and 6 months.PVT was an independent risk factor of HE in patients with HBV-related cirrhosis,especially in patients with HBV-related cirrhosis after TIPS.In addition,portal vein diameter widened and MELD score increase are independent risk factors for SBP in patients with HBV-related cirrhosis,especially in patients with HBV-related. |
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