保健医学研究与实践2025，Vol.22Issue(1)：54-60,7.DOI:10.11986/j.issn.1673-873X.2025.01.09
Cys-C、Hcy与肝硬化EGVB患者术后显性肝性脑病发生的关系
Relationship of Cys-C,Hcy with postoperative overt hepatic encephalopathy in cirrhotic patients with esophagogastric variceal bleeding
摘要
Abstract
Objective To explore the relationship of cystatin C(Cys-C)and homocysteine(Hcy)with postoperative overt he-patic encephalopathy(OHE)in cirrhotic patients with esophagogastric variceal bleeding(EGVB)treated with transjugular intrahepatic portosystemic shunt(TIPS).Methods This study enrolled 132 cirrhotic patients with EGVB who underwent TIPS at Affiliated Baoji Hospital of Xi'an Medical University from January 2021 to January 2024.Patients were assigned to OHE(n=42)and non-OHE(n=90)groups based on the presence or absence of OHE during follow-up.Clinical data in-cluding age,gender,BMI,preoperative portal vein diameter,Model for End-Stage Liver Disease(MELD)score,Child-Pugh class for liver function,diabetes,hypertension,ascites degree,and levels of hemoglobin,platelets,albumin,Cys-C,and Hcy were collected.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of Cys-C and Hcy for OHE after TIPS in cirrhotic patients with EGVB.Multivariate logistic stepwise regression analysis was per-formed to identify influencing factors for post-TIPS OHE.Results Serum Cys-C and Hcy levels in the OHE group were significantly higher than those in the non-OHE group(P<0.05).The AUCs(95%CI)for predicting OHE using Cys-C,Hcy,and their combination were 0.743(0.693-0.788),0.809(0.764-0.854),and 0.937(0.887-0.987),respective-ly.The OHE group had significantly longer preoperative main portal vein diameter(P<0.05),higher MELD scores(P<0.05),and higher proportions of Child-Pugh class C(P<0.05),diabetes(P<0.05),and massive ascites(P<0.05)compared to the non-OHE group.Multivariate logistic regression identified MELD score≥12.46(OR=2.113,95%CI:1.279-3.490),Child-Pugh class C(OR=2.547,95%CI:1.231-5.271),Cys-C≥1.80 mg/L(OR=3.529,95%CI:1.870-6.659),and Hcy≥18.86 μmol/L(OR=3.777,95%CI:1.876-7.604)as independent risk factors for OHE(P<0.05).Conclusion Serum Cys-C and Hcy are closely associated with post-TIPS OHE in cirrhotic EGVB patients.Combined use of these biomarkers markedly promotes prediction accuracy.Specifically,Cys-C≥1.80 mg/L and Hcy≥18.86 μmol/L indicate a considerably increased risk of OHE.Additionally,MELD scores and Child-Pugh class are critical prognostic indicators.关键词
胱抑素C/同型半胱氨酸/肝硬化/食管胃底静脉曲张/破裂出血Key words
Cystatin C/Homocysteine/Liver cirrhosis/Esophageal and gastric varices/Bleeding分类
临床医学引用本文复制引用
邓卫宁,周柯,李景源,赵瑛,申晓媛,彭相颖,吕远..Cys-C、Hcy与肝硬化EGVB患者术后显性肝性脑病发生的关系[J].保健医学研究与实践,2025,22(1):54-60,7.基金项目
陕西省重点研发计划项目(2023-YBSF-137). （2023-YBSF-137）
