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目的研究经颈静脉肝内门体分流术(TIPS)后肝性脊髓病(HM)的特征。方法回顾性纳入第四军医大学西京消化病医院消化介入科2005年-2014年肝硬化门静脉高压经TIPS手术成功治疗后发生HM的连续病例。所有患者于TIPS术后1、3、6个月以及之后每半年进行常规随访。根据疾病进展时间总结HM的自然病程,计量资料组间比较采用独立样本t检验;计数资料组间比较采用χ2检验。通过Kaplan-Meier法进行生存分析,并用Cox比例风险回归模型筛选其预后的预测因素,统计患者下肢症状缓解情况以分析其治疗效果。结果从HM 1级发展到2、3、4级的时间分别为4.0(1~36)个月、8.5(1~44个月和18.87(5.4~48.6)个月。HM患者1、3和5年累计生存率分别为84.19%、51.86%和45.21%。HM发病年龄[风险比(HR)=1.034,95%可信区间(95%CI):1.003~1.065]和再发腹水(HR=3.869,95%CI:1.623~9.225)是HM患者预后的独立预测因素。肝移植后症状缓解者所占比例显著高于未经肝移植者(χ2=13.5,P=0.003),而支架限流或封堵的效果差异无统计学意义(P>0.05)。结论HM的病程通常由快速进展期和平台期构成,TIPS术后HM患者生存情况较好,而目前肝移植是治疗HM有效的方法。
Objective To investigate the characteristics of hepatic myelopathy (HM) after transjugular intrahepatic portosystemic shunt (TIPS). Methods Retrospectively included in the Digestive Interventional Section of Xijin Digestive Disease Hospital of the Fourth Military Medical University between 2005 and 2014. Successive cases of HM occurred after successful treatment of portal hypertension with TIPS surgery. All patients were followed up routinely 1, 3, 6 months after TIPS and every six months after TIPS. According to the disease progression time to summarize the natural history of HM, measurement data were compared between groups using independent sample t test; count data were compared between groups using χ2 test. Survival analysis was performed by Kaplan-Meier method, and prognostic factors were screened by Cox proportional hazards regression model. The symptom relief of lower extremities was calculated to analyze the therapeutic effect. Results The time from development of HM 1 to grades 2, 3, and 4 were 4.0 (1-36) months, 8.5 (1-44 months and 18.87 (5.4-48.6) months, respectively) The annual cumulative survival rates were 84.19%, 51.86% and 45.21%, respectively.HM morbidity [hazard ratio (HR) = 1.034, 95% CI: 1.003-1.065] and recurrent ascites , 95% CI: 1.623 ~ 9.225) were independent predictors of prognosis in patients with HM. The proportion of symptomatic patients after liver transplantation was significantly higher than those without liver transplantation (χ2 = 13.5, P = 0.003) (P> 0.05) .Conclusion The course of HM usually consists of rapid progression and plateau, the survival of HM patients after TIPS is better, but liver transplantation is the effective method to treat HM.