Correlation Between Early Hepatic Encephalopathy And Detection Of Hepatic Reserve Function After TIPS

Objective:Through follow-up,we hope to study and analyze the risk factors related to the occurrence of hepatic encephalopathy after transjugular trahepatic portosystemic shunt(TIPS)in patients with portal hypertension,and explore the value of indocyanine green clearance test in predicting hepatic encephalopathy in the early postoperative period after TIPS.Methods:127 patients were included in this study,who received TIPS treatment in the Department of Gastroenterology,from January 1,2016 to December 31,2018.Among them,43 patients completed the liver reserve function test 1 week before surgery,1 week after surgery and 1 month after operation.1.We analyzed the correlation between basic information(including gender,age,portal vein thrombosis,Child-pugh score,Child-pugh grade,MELD score,MELD grade),Liver reserve function 1 week after surgery(ICG K,ICGR15,EHBF),imaging data(stent type,stent dianeter,portal vein pressure changes before and after stent placement,stent puncture site,right atrial pressure),liver function,renal function,electrolytes,blood routine,blood ammonia indicators and the occurrence of postoperative hepatic encephalopathy by Univariate analysis.In addition,the statistically significant results were included in the logistic regression analysis.2.43 patients who underwent TIPS treatment before surgery,1 week after stoperation.and 1 month after liver reserve examination were divided into hepatic encephalopathy group and non-hepatic encephalopathy group according to whether hepatic encephalopathy occurred after operation.The changes of liver reserve function indicators(including ICGK,ICGR15 and EHBF)before TIPS,1 week after TIPS and 1 month after TIPS were compared.The correlation between preoperative and postoperative liver reserve indexes(including ICG K,ICGR15 and EHBF)and hepatic encephalopathy was analyzed.We also analyzed the relationship between preoperative and postoperative liver reserve indexes(including ICGK,ICGR15 and EHBF),and Child-Pugh score as well as Child-Pugh grading.Results:1.Age,blood ammonia,portal pressure changes,ICGR15,ICGK are associated with postoperative hepatic encephalopathy.2.Logistic regression analysis showed that portal pressure changes,blood ammonia,and ICGR15 were risk factors for hepatic encephalopathy after TIPS.3.At 1 week and 1 month after TIPS,ICGR15 was increased in both groups compared with preoperative,ICGK decreased compared with preoperative,that is,liver reserve function decreased.ICGR15 was higher in the hepatic encephalopathy group than in the non-hepatic encephalopathy group.The ICG 15 in the hepatic encephalopathy group after TIPS was lower than that in the non-hepatic encephalopathy group.The differences of ICGR15 and ICGK levels between different Child-Pugh grades before TIPS,1 week after operation and 1 month after operation were statistically significant.Conclusion:1.Risk factors for hepatic encephalopathy after TIPS include blood ammonia,portal pressure changes,and postoperative liver reserve function(ICGR15 value).2.ICGR15 level can reflect liver reserve function.Child-Pugh grade is related to ICGR15.ICGR15 can be used as an important method to evaluate liver reserve function by TIPS.3.The liver reserve function of patients after TIPS decreased,which was manifested as increased ICGR15.The higher ICGR15,the higher the occurrence of postoperative hepatic encephalopathy.ICGR15 is of great significance in predicting the occurrence of hepatic encephalopathy after TIPS.