Hepatology, Liver Transplantation Unit, IIS La Fe and CIBER-EHD, Hospital Universitari i Politècnic La Fe, Valencia, Spain and Department of Medicine, Universitat de València, Valencia, Spain.
Acta Gastroenterol Belg. 2023 Apr-Jun;86(2):318-322. doi: 10.51821/86.2.11430.
Hepatic encephalopathy (HE) is one of the most severe complications following transjugular intrahepatic portosystemic shunt (TIPS). The identification and treatment of risk factors associated with the development of this complication may reduce the incidence and severity of post-TIPS HE. Several studies have demonstrated that the nutritional status plays a major role in the outcome of the cirrhotic population, particularly those who are decompensated. Although scarce, there are also studies highlighting an association between poor nutritional status, sarcopenia, fragile status, and post-TIPS HE. If these data are confirmed, nutritional support could become a means for decreasing this complication, thereby enhancing the use of TIPs in the treatment of refractory ascites or variceal bleeding. In this review, we will discuss the pathogenesis of HE, the data that supports an association with sarcopenia, nutritional status and frailty and the implications that these conditions have on the use of TIPS in clinical practice.
肝性脑病（HE）是经颈静脉肝内门体分流术（TIPS）后最严重的并发症之一。识别和治疗与该并发症发展相关的危险因素可能会降低 TIPS 后 HE 的发生率和严重程度。多项研究表明，营养状况在肝硬化患者的预后中起着重要作用，尤其是那些失代偿的患者。尽管研究较少，但也有研究强调了营养不良、肌肉减少症、脆弱状态与 TIPS 后 HE 之间的关联。如果这些数据得到证实，营养支持可能成为减少这种并发症的一种手段，从而提高 TIPS 在治疗难治性腹水或静脉曲张出血中的应用。在这篇综述中，我们将讨论 HE 的发病机制，支持其与肌肉减少症、营养状况和脆弱性相关的数据，以及这些情况对 TIPS 在临床实践中的应用的影响。
