肝性脊髓病的临床特征、预后及其影响因素分析  

Analysis of clinical characteristics,prognosis,and influencing factors of hepatic myelopathy

作　　者：薛文豪 刘仕睿 夏磊[1] 柴一鸣 徐鹏[1] 化召辉[1] 焦周阳[1] 曹辉[1] 李震[1] Xue Wenhao;Liu Shirui;Xia Lei;Chai Yiming;Xu Peng;Hua Zhaohui;Jiao Zhouyang;Cao Hui;Li Zhen(Department of Endovascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院腔内血管外科,郑州450052

出　　处：《中华医学杂志》2025年第9期701-707,共7页National Medical Journal of China

基　　金：国家自然科学基金(82370503)。

摘　　要：目的探讨肝性脊髓病(HM)临床特征、不同治疗的预后及其影响因素。方法回顾性分析郑州大学第一附属医院2016年6月至2023年6月诊治的134例HM患者临床资料,年龄(53.6±9.0)岁,男114例,女20例。根据治疗方法不同分为药物组(n=95)、介入组(n=23)和肝移植组(n=16);根据分流道类型不同分为自发分流组(n=84)和人工分流组(n=50)。分析不同组别患者的临床特征及并发症的情况。以Kaplan-Meier法绘制生存曲线,采用log-rank检验比较组间患者总生存率的差异。采用多因素Cox回归模型分析影响HM患者生存的相关因素。结果4例患者从单侧下肢起病并逐渐累及双下肢,余130例同时累及双下肢,其中9例合并双上肢。药物组、介入组及肝移植组患者肝癌占比[21.1%(20/95)比4.8%(1/23)比0,P=0.021]差异有统计学意义,性别和肝肾功能等指标差异均无统计学意义(均P>0.05)。药物组随访26(18,37)个月,1例病情好转、7例病情稳定、87例病情进展;介入组随访22(14,32)个月,11例支架限流者中,1例病情好转、2例病情稳定、8例病情进展;12例自发分流栓塞者,1例病情好转、1例病情稳定、10例无明显变化;肝移植组随访29(13,45)个月,1例术后1个月死亡,9例病情好转,4例病情稳定,2例病情进展。与药物组及介入组比较,肝移植组肝性脑病发生率最低[0比87(91.6%)比16(69.6%)]、疾病控制率最高[13(81.3%)比8(8.4%)比5(21.7%)],均P<0.001。Log-rank检验结果显示,药物组、介入组及肝移植组生存率差异无统计学意义(67.4%比69.6%比68.8%,P=0.849);自发分流组及人工分流组生存率差异无统计学意义(68.0%比67.9%,P=0.676)。估算HM患者1、3、5年生存率分别为88.8%、65.1%和46.5%。多因素Cox回归模型分析显示,Child-Pugh C级(以Child-Pugh A~B级为参照,HR=3.39,95%CI:1.57~7.32)和HM 3~4级(以HM 1~2级为参照,HR=2.65,95%CI:1.27~5.53)是影响HM患者生存(赋值以死亡为1,存活为0)的危险因素。结论Objective To investigate the clinical characteristics,prognosis of different treatments and influencing factors of hepatic myelopathy(HM).Methods The clinical data of 134 HM patients treated in the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2023 were retrospectively analyzed.The age of the patients was(53.6±9.0)years old,with 114 males and 20 females.According to different treatment methods,they were divided into drug group(n=95),intervention group(n=23)and liver transplantation group(n=16);according to the different types of shunt,they were divided into spontaneous shunt group(n=84)and manual shunt group(n=50).The clinical characteristics and complications of patients in different groups were analyzed.Kaplan-Meier method was used to draw the survival curve,and log-rank test was used to compare the difference of the overall survival rate between the groups.Multivariate Cox regression model was used to analyze the related factors affecting the survival of HM patients.Results Four patients started with unilateral lower limb involvement and gradually progressed to involve both lower limbs,while the remaining 130 patients had simultaneous involvement of both lower limbs,including 9 cases with additional involvement of both upper limbs.There were statistically significant differences in the proportion of liver cancer in the drug group,intervention group and liver transplantation group[21.1%(20/95)vs 4.8%(1/23)vs 0,P=0.021],while there were no significant differences in gender,liver and kidney function and other indicators(all P>0.05).In the drug group,the follow-up time was 26(18,37)months.One case improved,7 cases were stable,and 87 cases were progressive.In the intervention group,the follow-up time was 22(14,32)months.Among the 11 patients with stent flow restriction,1 case improved,2 cases were stable,and 8 cases were progressive.In 12 cases of spontaneous shunt embolization,1 case improved,1 case was stable,and 10 cases had no significant change.In the liver transplantation group,the

关 键 词：肝硬化 肝性脊髓病 自发分流道 经颈静脉肝内门体分流术 肝移植 

分 类 号：R73[医药卫生—肿瘤]