Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
Department of Gastroenterology, Sapienza" University of Rome, Latina, Italy.
Liver Int. 2019 May;39(5):871-877. doi: 10.1111/liv.14050. Epub 2019 Feb 6.
Hepatic encephalopathy (HE) is the major complication of transjugular intrahepatic portosystemic shunt (TIPS). In cirrhotic patients, a correlation between sarcopenia and HE has been suggested.
To evaluate the evolution of the skeletal muscle quantity and quality at CT scan and of the patients' cognitive impairment (both overt and minimal HE) before and after TIPS.
Twenty-seven cirrhotic patients submitted to TIPS were studied. The modification of Skeletal Muscle Index (SMI), muscle attenuation, HE and plasma ammonia were evaluated before and after a mean follow-up of 9.8 ± 4 months after TIPS.
During the follow-up, the mean SMI and muscle attenuation increased significantly, although not uniformly in all patients. Psychometric Hepatic Encephalopathy Score (PHES) and ammonia improved significantly in the patients with amelioration in SMI >10% (n = 16) and not in those without (n = 11) (PHES: -1.6 ± 2 vs -4.8 ± 2.1; P = 0.0005; ammonia: 48.5 ± 28.7 vs 96 ± 31.5 μg/dL; P = 0.0004). Moreover, the prevalence of minimal HE (12.5% vs 73%, P = 0.001) as well as the number of episodes of overt HE during the follow-up were significantly reduced in the patients with improved SMI. Model for end-stage liver disease remained stable or worsened after TIPS and was not significantly different between the groups with or without SMI improvement.
The amelioration of muscle wasting and HE independent of liver function observed after TIPS supports the causal relationship between muscle wasting and HE.
肝性脑病（HE）是经颈静脉肝内门体分流术（TIPS）的主要并发症。在肝硬化患者中，已经有人提出了肌肉减少症与 HE 之间的相关性。
评估 TIPS 前后 CT 扫描时骨骼肌数量和质量的变化以及患者的认知障碍（显性和轻微 HE）。
研究了 27 例接受 TIPS 的肝硬化患者。在 TIPS 后平均随访 9.8±4 个月后，评估了 Skeletal Muscle Index（SMI）、肌肉衰减、HE 和血浆氨的变化。
在随访期间，尽管并非所有患者的 SMI 和肌肉衰减均均匀增加，但平均值均显著增加。在 SMI 增加>10%（n=16）的患者中，精神状态肝性脑病评分（PHES）和氨明显改善，而在 SMI 未增加的患者中（n=11）则没有改善（PHES：-1.6±2 与-4.8±2.1；P=0.0005；氨：48.5±28.7 与 96±31.5 μg/dL；P=0.0004）。此外，在 SMI 改善的患者中，轻微 HE（12.5%比 73%，P=0.001）的患病率以及随访期间显性 HE 发作的次数均明显减少。TIPS 后模型终末期肝病评分保持稳定或恶化，并且在 SMI 改善或未改善的组之间没有显著差异。
TIPS 后观察到的肌肉减少症和 HE 的改善与肝功能无关，支持肌肉减少症与 HE 之间的因果关系。
