|
|
|
| Risk factors for hepatic encephalopathy in patients with chronic liver diseases |
| ZHANG Chun1, XIE Dan2, Mi Zhongyou1, SONG Zongtao3, GONG Biyan4 |
1. Department of Emergency Medicine,
2. Department of Health and Epidemic Prevention,
4. Department of General Surgery, Chongqing Municipal Corps Hospital of Chinese People's Armed Police Force,Chongqing 400061,China;
3. Department of Emergency Medicine,the First Affiliated Hospital of Army Military Medical University, Chongqing 400038,China |
|
|
|
|
Abstract Objective To explore the independent risk factors for hepatic encephalopathy (HE) in patients with liver diseases. Methods Sixty-four patients with HE who visited our hospital between 2014 and 2019 were enrolled in this study. These patients were divided into two groups: the male group (n=51) and female group(n=13). The clinical characteristics were compared between the two groups so as to find the difference between the two genders. The first definitive diagnosis of hepatitis or cirrhosis was taken as the starting point and the first attack of HE as the end point. Possible independent risk factors for HE were explored based on univariate and multivariate analysis. Results Univariate and multivariate analysis showed that age (OR: 1.066, P<0.0001), cirrhosis (7.979, P< 0.0001), hepatitis B virus infection and treatment (5.838, P<0.0001), splenomegaly (2.722, P= 0.003), esophagogastric varices (EGV, 1.986, P= 0.024) and ALT level (2.940, P<0.0001) were independent risk factors for HE. The 1-, 3-, 5- and 10-year incidence of HE was 14.06%, 34.38%, 42.19% and 85.94%, respectively. Conclusions Male HE patients have more of a pathological basis of cirrhosis and higher serum total bilirubin levels than female ones during the early stage. Age, cirrhosis, hepatitis B virus infection and anti-virus treatment, splenomegaly, EVG and serum ALT levels are potential clinical indicators for predicting HE attack in patients with liver diseases.
|
|
Received: 21 April 2021
|
|
|
|
|
|
| [1] |
Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J].Hepatology,2014,60(2):715-735.
|
| [2] |
Hsu S J, Zhang C, Jeong J,et al. Enhanced meningeal lymphatic drainage ameliorates neuroinflammation and hepatic encephalopathy in cirrhotic rats[J].Gastroenterology,2021,160(4):1315-1329.
|
| [3] |
Luo S, Zhou Z M, Guo D J, et al. Radiomics-based classification models for HBV-related cirrhotic patients with covert hepatic encephalopathy[J].Brain and Behavior,2021,11(2):1-11.
|
| [4] |
Chepkova A N, Sergeeva O A, Haas H L. Taurine rescues hippocampal long-term potentiation from ammonia-induced impairment[J].Neurobiol Dis,2006,23(3):512-521.
|
| [5] |
Hassan A, Tsuda Y, Asai A, et al. Effects of oral l-carnitine on liver functions after transarterial chemoembolization in intermediate-stage HCC patients[J]. Mediators Inflamm,2015,20(1):1-11.
|
| [6] |
Boer L A, Panatto J P, Fagundes D A, et al. Inhibition of mitochondrial respiratory chain in the brain of rats after hepatic failure induced by carbon tetrachloride is reversed by antioxidants[J].Brain Res Bull,2009,80(1-2):75-78.
|
| [7] |
Milewski K, Hilgier W, Fresko I, et al. Carnosine reduces oxidative stress and reverses attenuation of righting and postural reflexes in rats with thioacetamide-induced liver failure[J].Neurochem Res,2016, 41(1-2):376-384.
|
| [8] |
Bémeur C, Vaquero J, Desjardins P, et al. N-acetylcysteine attenuates cerebral complications of non-acetaminophen-induced acute liver failure in mice: antioxidant and anti-inflammatory mechanisms[J].Metab Brain Dis,2010,25(2):241-249.
|
| [9] |
Farshad O, Keshavarz P, Heidari R, et al. The potential neuroprotective role of citicoline in hepatic encephalopathy[J].J Exp Pharmacol,2020,12(1):517-527.
|
| [10] |
王建伟,刘素梅,杨宵曼,等.乙型肝炎肝衰竭患者发生肝性脑病的危险因素分析[J].中国实用神经疾病杂志,2017,20(2):69-71.
|
| [11] |
Rose C F,Amodio P,Bajaj J S, et al. Hepatic encephalopathy: novel insights into classification,pathophysiology and therapy[J].J Hepatol,2020,73(6):1526-1547.
|
| [12] |
徐小元,段钟平.肝硬化肝性脑病诊疗指南[J].西南医科大学学报,2018, 41(6):477-490.
|
| [13] |
王贵强,王福生,庄 辉,等.慢性乙型肝炎防治指南年版[J].临床肝胆病杂志,2019,35(12):2648-2669.
|
| [14] |
Ishii N, Mochizuki H, Sakai K, et al. Parkinsonism and high-intensity midbrain lesions on T2-weighted imaging in hepatic encephalopathy: a case report[J].Neurological Sciences,2017,38(8):1547-1549.
|
| [15] |
Jayakumar A R, Norenberg M D. Glutamine synthetase, role in neurological disorders[J]. Adv Neurobiol,2016,13(1):327-350.
|
| [16] |
Desjardins P, Du T, Jiang W, et al. Pathogenesis of hepatic encephalopathy and brain edema in acute liver failure: role of glutamine redefined[J].Neurochem Int,2012,60(7):690-696.
|
| [17] |
王小琴,杨小丽.乙型肝炎肝硬化合并肝性脑病的危险因素[J].肝脏,2019,24(11):1328-1329.
|
| [18] |
Cui Y, Guan S, Ding J, et al.Establishment and evaluation of a model for predicting 3-month mortality in Chinese patients with hepatic encephalopathy[J].Metabolic Brain Disease,2019,34(1):213-221.
|
| [19] |
Strebel H, Haller B, Sohn M, et al. Role of brain biomarkers S-100-Beta and neuron-specific enolase for detection and follow-up of hepatic encephalopathy in cirrhosis before,during and after treatment with L-Ornithine-L-Aspartate[J].GE - Portuguese Journal of Gastroenterology,2020,27(6):391-403.
|
| [20] |
Tong H, Gan C, Wei B, et al. Risk factors for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation in patients with liver cirrhosis[J]. Journal of Digestive Diseases,2021,22(1):31-40.
|
| [21] |
Chen S, Huang H, Liu Y, et al. A multi-parametric prognostic model based on clinical features and serological markers predicts overall survival in non-small cell lung cancer patients with chronic hepatitis B viral infection[J].Cancer Cell Int,2020, 20(1):555.
|
| [22] |
Nie Y, Deng X, Lan Y, et al. Comparison and correlation of genetic variability of the HBV Pre-S region in HIV/HBV co-infected patients: quasispecies perspective[J].Infection and Drug Resistance,2020,13(1):4327-4334.
|
| [23] |
Napolitano M, Franchi-Abella S, Damasio M B, et al. Practical approach to imaging diagnosis of biliary atresia, Part 1: prenatal ultrasound and magnetic resonance imaging, and postnatal ultrasound[J]. Pediatr Radiol,2021,51(2):314-331.
|
| [24] |
Kumar R, Kerbert A, Sheikh M F, et al. Determinants of mortality in patients with cirrhosis and uncontrolled variceal bleeding[J].J Hepatol,2021,74(1):66-79.
|
|
|
|
2021, Vol. 32 
