Incidence and efficacy of strategies for preventing hepatic encephalopathy following transjugular intrahepatic portosystemic shunt:A meta-analysis  

作　　者：Xiao-Tong Xu Min-Jie Jiang Yun-Lai Fu Fang Xie Jian-Jun Li Qing-Hua Meng 

机构地区：[1]Hepatic Disease and Oncology Minimally Invasive Interventional Center,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China [2]Beijing Institute of Hepatology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China [3]Department of Infectious Diseases,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong Province,China

出　　处：《World Journal of Hepatology》2025年第4期120-136,共17页世界肝病学杂志(英文)

摘　　要：BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.

关 键 词：Transjugular intrahepatic portal shunt Hepatic encephalopathy CIRRHOSIS Prevention LACTULOSE RIFAXIMIN 

分 类 号：R575.3[医药卫生—消化系统]