The effect on peripheral immune cells and the relationship between immune changes and hepatic encephalopathy following the decreasing of portal hypertension by transjugular intrahepatic portosystemic shunt
The effect on peripheral immune cells and the relationship between immune changes and hepatic encephalopathy following the decreasing of portal hypertension by transjugular intrahepatic portosystemic shunt
Objective The purpose of this study was to analyze the effect on peripheral immune cells and the relationship between immune changes and hepatic encephalopathy following the decreasing of portal hypertension by Transjugular intrahepatic portosystemic shunt(TIPS).Methods Clinical data were collected from 39 patients who were diagnosed with cirrhosis complicated with portal hypertension and varices and treated with TIPS at the Fifth Medical Center of PLA General Hosital from October 2020 to October 2022,these included the results of laboratory testsincluding the laboratory examination results at baseline,1 week after TIPS and 12 weeks after TIPS,as well as the occurrence of hepatic encephalopathy.The changes of peripheral immune cells and their correlation with the occurrence of hepatic encephalopathy were analyzed.Results Compared with baseline,the levels of white blood cell(WBC),absolute neutrophil cell(ANC),absolute monocytes cell(AMC),and CD8+T cells were increased at 1 week after TIPS,with statistically significant differences(P＜0.05).At 12 weeks after TIPS,the levels of WBC,CD8+T cells,and T lymphocytes were increased,with statistically significant differences(P＜0.05).Univariate Logistic regression analysis showed that age≥57 years(P=0.020),alanine aminotransferase(ALT)≥1 ULN(normal upper limit value)at 1 week after TIPS(P=0.041),moderate anemia before TIPS(P=0.083),and ANC＜1 ULN at 1 week after TIPS(P=0.051)may be risk factors for the development of hepatic encephalopathy.When these factors were included in the multivariate Logistic regression analysis,the results showed that age≥57 years(OR=8.333,95%CI:1.474～47.114),ALT≥1 ULN at 1 week after TIPS(OR=7.433,95%CI:1.257～43.949)were risk factors for the occurrence of hepatic encephalopathy,and ANC＜1 ULN at 1 week after TIPS(OR=0.140,95%CI:0.025～0.987)was protective factors for the occurrence of hepatic encephalopathy.The receiver operating characteristic(ROC)curve was used to evaluate the prediction accuracy,and the results showed that the area under curve of ANC＜1 ULN at 1 week after TIPS was 0.835(95%CI:0.695～0.974,P=0.000),indicating significant predictive value.Conclusions Patients with portal hypertension exhibited an increase in WBC and CD8+T cell counts at 1 week and 12 weeks after TIPS;ANC and AMC counts increased at 1 week after TIPS and recovered at 12 weeks after TIPS.Early changes in absolute neutrophil count can predict the occurrence of hepatic encephalopathy after TIPS.
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