Greinert Robin, Zipprich Alexander, Simón-Talero Macarena, Stangl Franz, Ludwig Christiane, Wienke Andreas, Praktiknjo Michael, Höhne Kevin, Trebicka Jonel, Genescà Joan, Ripoll Cristina
First Department of Internal Medicine, Martin-Luther University Halle-Wittenberg, Halle, Germany.
Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), CIBEREHD, Universitat Autònoma de Barcelona, Barcelona, Spain.
Liver Int. 2020 Dec;40(12):3093-3102. doi: 10.1111/liv.14660.
The aim of the study was to evaluate the presence of covert hepatic encephalopathy (cHE) and its characteristics according to the presence of spontaneous portosystemic shunts (SPSS) and their influence on the development of overt hepatic encephalopathy.
Secondary analysis of a multicentre study, which evaluated the association between SPSS and complications of cirrhosis. The present study population includes those patients who also underwent cHE diagnostic evaluation. Presence of SPSS was evaluated by cross-sectional imaging and quantified by total SPSS-area. Logistic and Cox-regression competing risk analyses were performed.
About 65 patients were included of age 58 (IQR 50-66), MELD 15 (IQR 10-20), with alcoholic liver disease 63%. Thirty-two patients (49%) had cHE, had higher MELD [16 (IQR 12-24) vs 13 (IQR 9-17), P = .027], a greater proportion of SPSS [n = 18 (56%) vs n = 8 (24%); P = .008] and a higher total cross-sectional SPSS-area [28.3 (0-94.2) vs 0 (0-14.1); P = .005]. On multivariate analysis MELD [OR 1.11 (95% CI 1.01-1.21)] and presence of SPSS [OR 3.95 (95% CI 1.22-12.80)] were independently associated to cHE at baseline. During follow-up cHE was an independent predictor of oHE [cHE: HR 6.93 (95% CI 2.64-18.20). The effect of cHE on the development of oHE was greater in patients with SPSS [only cHE: HR 5.66 (95% CI 1.82-17.62), cHE and SPSS: HR 8.63 (95% CI 3.15-23.65)].
cHE is independently associated to the presence of SPSS (and total cross-sectional SPSS-area) and MELD. Furthermore, the presence of SPSS seems to increase the risk of cHE of developing of overt hepatic encephalopathy.
本研究旨在根据自发性门体分流（SPSS）的存在情况评估隐匿性肝性脑病（cHE）的存在及其特征，以及它们对显性肝性脑病发生发展的影响。
对一项多中心研究进行二次分析，该研究评估了SPSS与肝硬化并发症之间的关联。本研究人群包括那些也接受了cHE诊断评估的患者。通过横断面成像评估SPSS的存在情况，并通过总SPSS面积进行量化。进行逻辑回归和Cox回归竞争风险分析。
纳入约65例患者，年龄58岁（四分位间距50 - 66），终末期肝病模型（MELD）评分15（四分位间距10 - 20），其中酒精性肝病患者占63%。32例患者（49%）患有cHE，其MELD评分更高[16（四分位间距12 - 24）对13（四分位间距9 - 17），P = 0.027]，SPSS比例更高[n = 18（56%）对n = 8（24%）；P = 0.008]，总横断面SPSS面积更大[28.3（0 - 94.2）对0（0 - 14.1）；P = 0.005]。多因素分析显示，MELD[比值比（OR）1.11（95%置信区间1.01 - 1.21）]和SPSS的存在[OR 3.95（95%置信区间1.22 - 12.80）]在基线时与cHE独立相关。在随访期间，cHE是显性肝性脑病（oHE）的独立预测因素[cHE：风险比（HR）6.93（95%置信区间2.64 - 18.20）]。cHE对oHE发生发展的影响在有SPSS的患者中更大[仅cHE：HR 5.66（95%置信区间1.82 - 17.62），cHE和SPSS：HR 8.63（95%置信区间3.15 - 23.65）]。
cHE与SPSS的存在（以及总横断面SPSS面积）和MELD独立相关。此外，SPSS的存在似乎增加了cHE发展为显性肝性脑病的风险。
