切换至 "中华医学电子期刊资源库"

中华介入放射学电子杂志 ›› 2026, Vol. 14 ›› Issue (02) : 135 -140. doi: 10.3877/cma.j.issn.2095-5782.2026.02.002

综述

经颈静脉肝内门体分流术后肝性脑病研究进展与新视角
张信哲1,2, 赵婷婷1,2, 王辉1,2, 张粉娜1, 冯巩2, 雒博晗3, 贺娜1,()   
  1. 1 710077 陕西西安,西安医学院第一附属医院
    2 710021 陕西西安,西安医学院
    3 710061 陕西西安,西安国际医学中心医院
  • 收稿日期:2025-07-02 出版日期:2026-05-25
  • 通信作者: 贺娜
  • 基金资助:
    北京肝胆相照公益基金人工肝专项基金(iGandanF-1082022-RGG010); 陕西化生基础科学研究项目(22JHQ091)

Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt: Research Progress and New Perspectives

Xinzhe Zhang1,2, Tingting Zhao1,2, Hui Wang1,2, Fenna Zhang1, Gong Feng2, Bohan Luo3, Na He1,()   

  1. 1 The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
    2 Xi'an Medical University, Xi'an 710021, China
    3 Xi'an International Medical Center Hospital, Xi'an 710061, China
  • Received:2025-07-02 Published:2026-05-25
  • Corresponding author: Na He
引用本文:

张信哲, 赵婷婷, 王辉, 张粉娜, 冯巩, 雒博晗, 贺娜. 经颈静脉肝内门体分流术后肝性脑病研究进展与新视角[J/OL]. 中华介入放射学电子杂志, 2026, 14(02): 135-140.

Xinzhe Zhang, Tingting Zhao, Hui Wang, Fenna Zhang, Gong Feng, Bohan Luo, Na He. Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt: Research Progress and New Perspectives[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(02): 135-140.

全球肝硬化疾病负担沉重,其中门静脉高压症是失代偿期肝硬化最常见的并发症之一,严重影响患者生存质量。经颈静脉门体分流术在缓解门静脉压力的同时,也会使肠源性毒素进入体循环,进而血氨水平快速升高,诱发肝性脑的发生,这一问题严重限制了该技术在临床的推广。本研究将从病理生理机制、疾病诊断及术后管理等多方面出发,探讨经颈静脉门体分流术后肝性脑病(transjugular intrahepatic portosystemic shunt-associated hepatic encephalopathy, TIPS-HE)与传统肝性脑病的差异,为TIPS-HE精准防治提供新的视角。

The global disease burden of cirrhosis is heavy, with portal hypertension being one of the most common complications of decompensated cirrhosis, severely affecting the quality of patient survival. While relieving portal pressure, transjugular intrahepatic portosystemic shunt (TIPS) also brings enterogenous toxins into the body circulation, with a consequent rapid increase in blood ammonia levels, which induces hepatic encephalopathy, severely limiting the promotion of this technique in the clinic. This study will explore the differences between transjugular intrahepatic portosystemic shunt–associated hepatic encephalopathy (TIPS-HE) and conventional hepatic encephalopathy from the aspects of pathophysiologic mechanism, disease diagnosis and postoperative management, providing a new perspective for the precise prevention and treatment of TIPS-HE.

图1 TIPS-HE的发病机制流程图 TIPS-HE:经颈静脉肝内门体分流术术后肝性脑病。
[1]
Liu YB, Chen MK. Epidemiology of liver cirrhosis and associated complications: current knowledge and future directions[J]. World J Gastroenterol, 2022, 28(41): 5910-5930.
[2]
García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med, 2010, 362(25): 2370-2379.
[3]
Nardelli S, Riggio O, Marra F, et al. Episodic overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt does not increase mortality in patients with cirrhosis[J]. J Hepatol, 2024, 80(4): 596-602.
[4]
Praktiknjo M, Abu-Omar J, Chang J, et al. Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation[J]. JHEP Rep, 2021, 3(3): 100264.
[5]
Wijdicks EF. Hepatic Encephalopathy[J]. N Engl J Med, 2016, 375(17): 1660-1670.
[6]
Labenz C, Schmidtke L, Pitton MB, et al. Ammonia levels after TIPS insertion identify patients at high risk of hepatic encephalopathy[J]. Clin Gastroenterol Hepatol, 2025, 10: S1542-3565(25)367-2.
[7]
Friis KH, Thomsen KL, Laleman W, et al. Post-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy—a review of the past decade's literature focusing on incidence, risk factors, and prophylaxis[J]. J Clin Med, 2023, 13(1): 14.
[8]
He X, Hu M, Xu Y, et al. The gut–brain axis underlying hepatic encephalopathy in liver cirrhosis[J]. Nat Med, 2025, 31(2): 627-638.
[9]
Nardelli S, Lattanzi B, Merli M, et al. Muscle alterations are associated with minimal and overt hepatic encephalopathy in patients with liver cirrhosis[J]. Hepatology, 2019, 70(5): 1704-1713.
[10]
Yin L, Chu SL, Lv WF, et al. Contributory roles of sarcopenia and myosteatosis in development of overt hepatic encephalopathy and mortality after transjugular intrahepatic portosystemic shunt[J]. World J Gastroenterol, 2023, 29(18): 2875-2887.
[11]
Liu J, Ma J, Yang C, et al. Sarcopenia in patients with cirrhosis after transjugular intrahepatic portosystemic shunt placement[J]. Radiology, 2022, 303(3): 711-719.
[12]
Rose CF, Amodio P, Bajaj JS, et al. Hepatic encephalopathy: novel insights into classification, pathophysiology and therapy[J]. J Hepatol, 2020, 73(6): 1526-1547.
[13]
Tiede A, Stockhoff L, Liu Z, et al. Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis[J]. Clin Mol Hepatol, 2025, 31(1): 240-255.
[14]
Li J, Liu Y, Li M, et al. Association of preoperative IL-6 levels with overt HE in patients with cirrhosis after TIPS[J]. Hepatol Commun, 2023, 7(4): e0128.
[15]
Bai Y, Li K, Li X, Chen X, et al. Effects of oxidative stress on hepatic encephalopathy pathogenesis in mice[J]. Nat Commun, 2023, 14(1): 4456.
[16]
Lu K. Cellular pathogenesis of hepatic encephalopathy: an update[J]. Biomolecules, 2023, 13(2): 396.
[17]
Bobermin LD, Wartchow KM, Flores MP, et al. Ammonia-induced oxidative damage in neurons is prevented by resveratrol and lipoic acid with participation of heme oxygenase 1[J]. Neurotoxicology, 2015, 49: 28-35.
[18]
Bajaj JS. The role of microbiota in hepatic encephalopathy[J]. Gut Microbes, 2014, 5(3): 397-403.
[19]
Li M, Li K, Tang S, et al. Restoration of the gut microbiota is associated with a decreased risk of hepatic encephalopathy after TIPS[J]. JHEP Rep, 2022, 4(5): 100448.
[20]
中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南(2024年版)[J]. 中华肝脏病杂志, 2024, 32(9): 799-812.
[21]
European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatic encephalopathy[J]. J Hepatol, 2022, 77(3): 807-824.
[22]
Berlioux P, Robic MA, Poirson H, et al. Pre-transjugular intrahepatic portosystemic shunts (TIPS) prediction of post-TIPS overt hepatic encephalopathy: the critical flicker frequency is more accurate than psychometric tests[J]. Hepatology, 2014, 59(2): 622-629.
[23]
Ehrenbauer AF, Schneider H, Stockhoff L, et al. Predicting overt hepatic encephalopathy after TIPS: value of three minimal hepatic encephalopathy tests[J]. JHEP Rep, 2023, 5(9): 100829.
[24]
Chen X, Huang M, Yu X, et al. Hepatic-associated vascular morphological assessment to predict overt hepatic encephalopathy before TIPS: a multicenter study[J]. Hepatol Int, 2024, 18(4): 1238-1248.
[25]
Chen X, Wang T, Ji Z, et al. 3D automatic liver and spleen assessment in predicting overt hepatic encephalopathy before TIPS: a multi-center study[J]. Hepatol Int, 2023, 17(6): 1545-1556.
[26]
Wang Y, Yang L, Shang Y, et al. Identifying Minimal hepatic encephalopathy: a new perspective from magnetic resonance imaging[J]. J Magn Reson Imaging, 2025, 61(1): 11-24.
[27]
İnce O, Önder H, Gençtürk M, et al. Machine learning insights: predicting hepatic encephalopathy after TIPS placement[J]. Cardiovasc Intervent Radiol, 2023, 46(12): 1715-1725.
[28]
Ahmed Z, Farooq U, Faiza Arif S, et al. Transjugular intrahepatic portosystemic shunt outcomes in the elderly population: a systematic review and meta-analysis[J]. Gastroenterology Res, 2022, 15(6): 325-333.
[29]
Kabelitz MA, Sandmann L, Praktiknjo M, et al. Early occurrence of hepatic encephalopathy following TIPS-insertion is linked to impaired survival: a multicenter cohort study[J]. Clin Gastroenterol Hepatol, 2025, 23(12): 2214-2223. e27.
[30]
Tsai CF, Chen MH, Wang YP, et al. Proton pump inhibitors increase risk for hepatic encephalopathy in patients with cirrhosis in a population study[J]. Gastroenterology, 2017, 152(1): 134-141.
[31]
Merola J, Chaudhary N, Qian M, et al. Hyponatremia: a risk factor for early overt encephalopathy after transjugular intrahepatic portosystemic shunt creation[J]. J Clin Med, 2014, 3(2): 359-372.
[32]
Kabelitz MA, Hartl L, Schaub G, et al. Identification of optimal portal pressure decrease to control ascites while minimizing HE after TIPS: a multicenter study[J]. Hepatology, 2025, 82(5): 1172-1186.
[33]
Lv Y, Wang Q, Luo B, et al. Identifying the optimal measurement timing and hemodynamic targets of portal pressure gradient after TIPS in patients with cirrhosis and variceal bleeding[J]. J Hepatol, 2025, 82(2): 245-257.
[34]
Wang Q, Lv Y, Bai M, et al. Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding[J]. J Hepatol, 2017, 67(3): 508-516.
[35]
Simón-Talero M, Roccarina D, Martínez J, et al. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis[J]. Gastroenterology, 2018, 154(6): 1694-1705. e4.
[36]
Vidal-González J, Quiroga S, Simón-Talero M, et al. Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem[J]. Ther Adv Gastroenterol, 2020, 13: 1756284820961287.
[37]
Ursic M, Ravnik D, Hribernik M, et al. Gross anatomy of the portal vein and hepatic artery ramifications in dogs: corrosion cast study[J]. Anat Histol Embryol, 2007, 36(2): 83-87.
[38]
Bai M, He CY, Qi XS, et al. Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt[J]. World J Gastroenterol, 2014, 20(3): 774-785.
[39]
Luo SH, Chu JG, Huang H, et al. Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy[J]. World J Gastroenterol, 2019, 25(9): 1088-1099.
[40]
de Wit K, Schaapman JJ, Nevens F, et al. Prevention of hepatic encephalopathy by administration of rifaximin and lactulose in patients with liver cirrhosis undergoing placement of a transjugular intrahepatic portosystemic shunt (TIPS): a multicentre randomised, double blind, placebo controlled trial (PEARL trial)[J]. BMJ Open Gastroenterol, 2020, 7(1): e000531.
[41]
Hu Y, Zhang X, Xiao Y, et al. Efficacy and safety of rifaximin in preventing hepatic encephalopathy: a systematic review and meta-analysis[J]. PLoS One, 2025, 20(5): e0323359.
[42]
Lee EW, Eghtesad B, Garcia-Tsao G, et al. AASLD practice guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage[J]. Hepatology, 2024, 79(1): 224-250.
[43]
Bai M, He C, Yin Z, et al. Randomised clinical trial: L-ornithine-L-aspartate reduces significantly the increase of venous ammonia concentration after TIPSS[J]. Aliment Pharmacol Ther, 2014, 40(1): 63-71.
[44]
Konstantis G, Pourzitaki C, Chourdakis M, et al. Efficacy of branched chain amino acids supplementation in liver cirrhosis: a systematic review and meta-analysis[J]. Clin Nutr, 2022, 41(6): 1171-1190.
[45]
Hassouneh R, Bajaj JS. Gut microbiota modulation and fecal transplantation: an overview on innovative strategies for hepatic encephalopathy treatment[J]. J Clin Med, 2021, 10(2): 330.
[46]
Wang Q, Lv L, Jiang H, et al. Lactobacillus helveticus R0052 alleviates liver injury by modulating gut microbiome and metabolome in D-galactosamine-treated rats[J]. Appl Microbiol Biotechnol, 2019, 103(23-24): 9673-9686.
[47]
Bloom PP, Tapper EB, Young VB, et al. Microbiome therapeutics for hepatic encephalopathy[J]. J Hepatol, 2021, 75(6): 1452-1464.
[48]
Trebicka J, Garcia-Tsao G. Controversies regarding albumin therapy in cirrhosis[J]. Hepatology, 2025, 81(1): 288-303.
[49]
Fagan A, Gavis EA, Gallagher ML, et al. A double-blind randomized placebo-controlled trial of albumin in outpatients with hepatic encephalopathy: HEAL study[J]. J Hepatol, 2023, 78(2): 312-321.
[50]
Riggio O, Nardelli S, Pasquale C, et al. No effect of albumin infusion on the prevention of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J]. Metab Brain Dis, 2016, 31(6): 1275-1281.
[51]
European Association for the Study of the Liver. EASL clinical practice guidelines on TIPS[J]. J Hepatol, 2025, 83(1): 177-210.
[52]
Johnson CD, Stevens CM, Bennett MR, et al. The role of vitamin D deficiency in hepatic encephalopathy: a review of pathophysiology, clinical outcomes, and therapeutic potential[J]. Nutrients, 2024, 16(23): 4007.
[53]
Diaz-Ruiz R, Poca M, Roman E, et al. Vitamin D supplementation is associated with inflammation amelioration and cognitive improvement in decompensated patients with cirrhosis[J]. Nutrients, 2025, 17(2): 226.
[54]
何创业, 陈辉, 吕勇, 等. 限流支架治疗经颈静脉肝内门体分流术后复发性或持续性显性肝性脑病的效果和安全性[J]. 临床肝胆病杂志, 2019, 35(8): 1719-1722.
[55]
Reiberger T, Hofer BS. The Baveno Ⅶ concept of cirrhosis recompensation[J]. Dig Liver Dis, 2023, 55(4): 431-441.
[56]
Villanueva C, Albillos A, Genescà J, et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial[J]. Lancet, 2019, 393(10181): 1597-1608.
[57]
Sánchez J, González S, Poyatos P, et al. Recompensation after TIPS reduces the incidence of hepatocellular carcinoma and increases survival in patients with cirrhosis[J]. Liver Int, 2024, 44(11): 3072-3082.
[1] 李丁洋, 党晓卫. 脾动脉部分栓塞术治疗门静脉高压症合并脾功能亢进的精准实践与策略[J/OL]. 中华普通外科学文献(电子版), 2026, 20(02): 79-84.
[2] 王卫东. 贲门周围血管离断与左膈下静脉的保留[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 464-464.
[3] 吴鹏, 许维, 郑世海, 宋劲松. 脾静脉近端结扎在腹腔镜脾切除术后预防门静脉血栓形成的疗效分析[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(01): 59-62.
[4] 丁小博, 陈洁, 王艳波. 人工智能在泌尿系结石诊治中的应用进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(01): 15-21.
[5] 王孟龙. 门静脉高压症肝脏血供改变对肝移植的影响与对策[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(05): 687-692.
[6] 张宏伟, 邢玉雪, 贾哲, 赫嵘, 张珂, 蒋力. 术前输注血小板在肝癌合并肝硬化门静脉高压症肝脾联合切除患者中的疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 576-581.
[7] 石洋, 郭辉, 李坚. 门静脉高压症TIPS操作规范及其手术相关并发症处理[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(03): 372-378.
[8] 何竟. 脑外伤康复的进展与未来发展趋势[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(01): 1-9.
[9] 张群青, 吴娟, 王妍. 肝硬化门静脉高压症患者肝脏血流动力学指标与门静脉压力梯度的相关性[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(06): 616-620.
[10] 李海哲, 刘攀, 邹永彪, 张春华, 王璐, 李艳芳. 血清高迁移率族蛋白B1 与肝硬化并发肝性脑病严重程度的相关性及诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(03): 256-261.
[11] 陈镇, 余天垒, 刘晓超, 尹萌. 肝硬化门静脉高压伴上消化道急性出血患者的血细胞参数、肾功能及营养评分变化及其与预后的相关性[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(02): 149-154.
[12] 方海丽, 王俊, 栾琳. HBV 相关慢加急性肝衰竭患者诱发肝性脑病风险列线图模型构建与验证应用[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(02): 144-148.
[13] 董丽, 张永慧, 成德雷, 周春泽, 殷亮, 胡成文. 校正后低体质量指数与门静脉高压症患者经颈静脉肝内门体分流术预后相关性研究[J/OL]. 中华介入放射学电子杂志, 2026, 14(01): 12-19.
[14] 罗骏阳, 吴佳霖, 姜在波. 经肝中静脉TIPS技术:肝静脉与门静脉空间关系和距离的CT影像研究[J/OL]. 中华介入放射学电子杂志, 2025, 13(03): 234-239.
[15] 王聪, 姜华, 彭文凯, 汪祖鑫, 李松蔚. 经颈静脉肝内门体分流术与肝性脑病相关研究的文献计量学分析[J/OL]. 中华介入放射学电子杂志, 2025, 13(02): 152-163.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?