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Abstract：
BACKGROUND: Portal shunt and immune status related to the spleen are related to the occurrence of hepatic encephalopathy (HE). It is unknown whether spleen volume before transjugular intrahepatic portosystemic shunt (TIPS) is related to postoperative HE.
OBJECTIVE: To investigate the relationship between spleen volume and the occurrence of HE.
METHODS: This study included 135 patients with liver cirrhosis who underwent TIPS, and liver and spleen volumes were elevated upon computed tomography imaging. The Kaplan-Meier curve was used to compare the difference in the incidence rate of HE among patients with different spleen volumes. Univariate and multivariate Cox regression analyses were performed to identify the factors affecting overt HE (OHE). Restricted cubic spline was used to examine the shapes of the dose-response association between spleen volumes and OHE risk.
RESULTS: The results showed that 37 (27.2%) of 135 patients experienced OHE during a 1-year follow-up period. Compared with preoperative spleen volume (901.30 ± 471.90 cm3), there was a significant decrease in spleen volume after TIPS (697.60 ± 281.0 cm3) in OHE patients. As the severity of OHE increased, the spleen volume significantly decreased (P < 0.05). Compared with patients with a spleen volume ≥ 782.4 cm3, those with a spleen volume < 782.4 cm3 had a higher incidence of HE (P < 0.05). Cox regression analysis showed that spleen volume was an independent risk factor for post-TIPS OHE (hazard ratio = 0.494, P < 0.05). Restricted cubic spline model showed that with an increasing spleen volume, OHE risk showed an initial increase and then decrease (P < 0.05).
CONCLUSIONS: Spleen volume is related to the occurrence of OHE after TIPS. Preoperative spleen volume is an independent risk factor for post-TIPS OHE.
OBJECTIVE: To investigate the relationship between spleen volume and the occurrence of HE.
METHODS: This study included 135 patients with liver cirrhosis who underwent TIPS, and liver and spleen volumes were elevated upon computed tomography imaging. The Kaplan-Meier curve was used to compare the difference in the incidence rate of HE among patients with different spleen volumes. Univariate and multivariate Cox regression analyses were performed to identify the factors affecting overt HE (OHE). Restricted cubic spline was used to examine the shapes of the dose-response association between spleen volumes and OHE risk.
RESULTS: The results showed that 37 (27.2%) of 135 patients experienced OHE during a 1-year follow-up period. Compared with preoperative spleen volume (901.30 ± 471.90 cm3), there was a significant decrease in spleen volume after TIPS (697.60 ± 281.0 cm3) in OHE patients. As the severity of OHE increased, the spleen volume significantly decreased (P < 0.05). Compared with patients with a spleen volume ≥ 782.4 cm3, those with a spleen volume < 782.4 cm3 had a higher incidence of HE (P < 0.05). Cox regression analysis showed that spleen volume was an independent risk factor for post-TIPS OHE (hazard ratio = 0.494, P < 0.05). Restricted cubic spline model showed that with an increasing spleen volume, OHE risk showed an initial increase and then decrease (P < 0.05).
CONCLUSIONS: Spleen volume is related to the occurrence of OHE after TIPS. Preoperative spleen volume is an independent risk factor for post-TIPS OHE.
摘要：
背景：与脾脏相关的门静脉分流和免疫状态与肝性脑病（HE）的发生有关。目前尚不清楚经颈静脉肝内门体分流术（TIPS）前的脾脏体积是否与术后HE有关。
目的：探讨脾脏体积与HE发生的关系。
方法：本研究包括135例肝硬化患者，计算机断层扫描成像时肝脏和脾脏体积升高。采用Kaplan-Meier曲线比较不同脾体积患者HE发生率的差异。进行单因素和多因素Cox回归分析以确定影响明显HE（OHE）的因素。限制性三次样条用于检查脾脏体积和OHE风险之间的剂量反应关系的形状。
结果：结果显示，在1年的随访期内，135例患者中有37例（27.2％）发生了OHE。与术前脾脏体积(901.30±471.90cm3)比较,OHE患者TIPS后脾脏体积显著减少(697.60±281.0cm3)。随着OHE的严重程度增加，脾脏体积显著减小(P<0.05)。与脾脏体积≥782.4cm3的患者相比，脾脏体积<782.4cm3的患者HE发生率更高（P<0.05）。Cox回归分析显示,脾脏体积是TIPS术后OHE的独立危险因素(风险比=0.494,P<0.05)。限制性三次样条模型表明,随着脾脏体积的增加,OHE风险呈现先升高后降低(P<0.05)。
结论：脾脏体积与TIPS后OHE的发生有关。术前脾脏体积是TIPS术后OHE的独立危险因素。
目的：探讨脾脏体积与HE发生的关系。
方法：本研究包括135例肝硬化患者，计算机断层扫描成像时肝脏和脾脏体积升高。采用Kaplan-Meier曲线比较不同脾体积患者HE发生率的差异。进行单因素和多因素Cox回归分析以确定影响明显HE（OHE）的因素。限制性三次样条用于检查脾脏体积和OHE风险之间的剂量反应关系的形状。
结果：结果显示，在1年的随访期内，135例患者中有37例（27.2％）发生了OHE。与术前脾脏体积(901.30±471.90cm3)比较,OHE患者TIPS后脾脏体积显著减少(697.60±281.0cm3)。随着OHE的严重程度增加，脾脏体积显著减小(P<0.05)。与脾脏体积≥782.4cm3的患者相比，脾脏体积<782.4cm3的患者HE发生率更高（P<0.05）。Cox回归分析显示,脾脏体积是TIPS术后OHE的独立危险因素(风险比=0.494,P<0.05)。限制性三次样条模型表明,随着脾脏体积的增加,OHE风险呈现先升高后降低(P<0.05)。
结论：脾脏体积与TIPS后OHE的发生有关。术前脾脏体积是TIPS术后OHE的独立危险因素。
