Jalan R, Gooday R, O'Carroll R E, Redhead D N, Elton R A, Hayes P C
Centre for Liver and Digestive Diseases, Department of Medicine, Royal Infirmary, Edinburgh, UK.
J Hepatol. 1995 Dec;23(6):697-705. doi: 10.1016/0168-8278(95)80036-0.
BACKGROUND/AIMS: This study was designed to assess changes in: (a) neuropsychological tests, measures of memory, quality of life and scores for anxiety and depression; (b) liver function tests; and (c) the relationship between these following transjugular intrahepatic portosystemic stent-shunt.
Twenty-nine patients undergoing transjugular intrahepatic portosystemic stent-shunt for recurrent variceal haemorrhage, 12 matched patients with cirrhosis and variceal haemorrhage managed with variceal band ligation and 16 normal controls were studied. Patients in any of the groups who were clinically encephalopathic were excluded from the study. Serial changes in the conventional liver function tests and Indocyanine green clearance, and psychometric function (Hospital Anxiety Depression Scale, Rivermead Behavioral Memory Test, Quality of Life and the memory and reaction sub-tests of the Cambridge Automated Neuropsychological Test Assessment Battery) were measured prior to and 1, 3, 9 and 15 months following transjugular intrahepatic porto-systemic stent-shunt.
Over a mean follow up of 9.1 months in the transjugular intrahepatic portosystemic stent-shunt group (range 3-28), one patient (3%) developed clinically detectable encephalopathy. Sixty-seven percent of patients with cirrhosis showed evidence of subclinical encephalopathy as compared with the control population. Significant deterioration occurred in the reaction sub-tests of the Cambridge Automated Neuropsychological Test Assessment Battery in patients, both in the transjugular intrahepatic portosystemic stent-shunt group and the controls with cirrhosis, during follow up. Transjugular intrahepatic portosystemic stent-shunt was followed by significant deterioration in levels of anxiety and psychological component of the quality of life. The Rivermead Behavioural Memory Test and the memory sub-test of the Cambridge Automated Neuropsychological Test Assessment Battery did, however, improve significantly at 1 and 15 months after transjugular intrahepatic portosystemic stent-shunt, respectively. Serum alanine aminotransferase, bilirubin and indocyanine green clearance deteriorated significantly following transjugular intrahepatic portosystemic stent-shunt (p <0.001, p <0.001 and p <0.0001, respectively). Significant correlation was observed between changes in the indocyanine green clearance and changes in the complex and simple reaction time subtests of the Cambridge Automated Neuropsychological Test Assessment Battery (r = 0.6 and r = 0.66, respectively).
The results of this study showed that about 67% of patients with cirrhosis were subclinically encephalopathic and that temporary deterioration occurred in the Cambridge Automated Neuropsychological Test Assessment Battery during follow up, both in patients having transjugular intrahepatic portosystemic stent-shunt and in the controls with cirrhosis. These parallel the changes in the liver function tests and indocyanine green clearance. Temporary deterioration was also observed in the Quality of Life and Hospital Anxiety Depression Scale in the transjugular intrahepatic portosystemic stent-shunt group, although the measures of memory improved. Further studies should address the biochemical mechanisms of these changes and the role of prophylactic measures.
背景/目的：本研究旨在评估以下方面的变化：（a）神经心理测试、记忆力测量、生活质量以及焦虑和抑郁评分；（b）肝功能测试；（c）经颈静脉肝内门体分流术后这些指标之间的关系。
对29例行经颈静脉肝内门体分流术治疗复发性静脉曲张出血的患者、12例采用静脉曲张套扎术治疗的肝硬化合并静脉曲张出血的匹配患者以及16名正常对照者进行研究。排除临床出现肝性脑病的任何组别的患者。在经颈静脉肝内门体分流术前以及术后1、3、9和15个月，测量常规肝功能测试和吲哚菁绿清除率的系列变化以及心理测量功能（医院焦虑抑郁量表、里弗米德行为记忆测试、生活质量以及剑桥自动神经心理测试评估电池组的记忆和反应子测试）。
经颈静脉肝内门体分流术组平均随访9.1个月（范围3 - 28个月），1例患者（3%）出现临床可检测到的肝性脑病。与对照组相比，67%的肝硬化患者有亚临床肝性脑病的证据。在随访期间，经颈静脉肝内门体分流术组患者以及肝硬化对照组患者的剑桥自动神经心理测试评估电池组的反应子测试均出现显著恶化。经颈静脉肝内门体分流术后，焦虑水平和生活质量的心理成分显著恶化。然而，里弗米德行为记忆测试以及剑桥自动神经心理测试评估电池组的记忆子测试分别在经颈静脉肝内门体分流术后1个月和15个月时显著改善。经颈静脉肝内门体分流术后，血清丙氨酸氨基转移酶、胆红素和吲哚菁绿清除率显著恶化（分别为p <0.001、p <0.001和p <0.0001）。观察到吲哚菁绿清除率的变化与剑桥自动神经心理测试评估电池组的复杂和简单反应时间子测试的变化之间存在显著相关性（分别为r = 0.6和r = 0.66）。
本研究结果表明，约67%的肝硬化患者存在亚临床肝性脑病，并且在随访期间，经颈静脉肝内门体分流术患者和肝硬化对照组患者的剑桥自动神经心理测试评估电池组均出现暂时恶化。这些变化与肝功能测试和吲哚菁绿清除率的变化平行。经颈静脉肝内门体分流术组在生活质量和医院焦虑抑郁量表方面也观察到暂时恶化，尽管记忆力测量有所改善。进一步的研究应探讨这些变化的生化机制以及预防措施的作用。
