[Analysis of clinical characteristics, prognosis, and influencing factors of hepatic myelopathy].

Abstract

Objective: To investigate the clinical characteristics, prognosis of different treatments and influencing factors of hepatic myelopathy (HM). Methods: The clinical data of 134 HM patients treated in the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2023 were retrospectively analyzed. The age of the patients was (53.6±9.0) years old, with 114 males and 20 females. According to different treatment methods, they were divided into drug group (n=95), intervention group (n=23) and liver transplantation group (n=16); according to the different types of shunt, they were divided into spontaneous shunt group (n=84) and manual shunt group (n=50). The clinical characteristics and complications of patients in different groups were analyzed. Kaplan-Meier method was used to draw the survival curve, and log-rank test was used to compare the difference of the overall survival rate between the groups. Multivariate Cox regression model was used to analyze the related factors affecting the survival of HM patients. Results: Four patients started with unilateral lower limb involvement and gradually progressed to involve both lower limbs, while the remaining 130 patients had simultaneous involvement of both lower limbs, including 9 cases with additional involvement of both upper limbs. There were statistically significant differences in the proportion of liver cancer in the drug group, intervention group and liver transplantation group [21.1% (20/95) vs 4.8%(1/23) vs 0,P=0.021], while there were no significant differences in gender, liver and kidney function and other indicators (all P>0.05). In the drug group, the follow-up time was 26 (18, 37) months. One case improved, 7 cases were stable, and 87 cases were progressive. In the intervention group, the follow-up time was 22 (14, 32) months. Among the 11 patients with stent flow restriction, 1 case improved, 2 cases were stable, and 8 cases were progressive. In 12 cases of spontaneous shunt embolization, 1 case improved, 1 case was stable, and 10 cases had no significant change. In the liver transplantation group, the follow-up time was 29 (13, 45) months. One case died 1 month after operation, 9 cases improved, 4 cases were stable, and 2 cases progressed. Compared to the drug group and the intervention group, the liver transplantation group had the lowest incidence of hepatic encephalopathy [0 vs 87 (91.6%) vs 16 (69.6%)] and the highest disease control rate [13 (81.3%)vs 8 (8.4%) vs 5 (21.7%)],all P<0.001. Log-rank test results showed that there was no significant difference in survival rate between drug group, intervention group and liver transplantation group (67.4% vs 69.6% vs 68.8%, P=0.849). There was no significant difference in survival rate between spontaneous shunt group and manual shunt group (68.0% vs 67.9%, P=0.676). The estimated 1, 3, and 5 years survival rates for HM patients were 88.8%, 65.1%, and 46.5%, respectively. Multivariate Cox regression analysis showed that Child-Pugh C class (with Child-Pugh A-B class as the reference,HR=3.39, 95%CI: 1.57-7.32) and HM 3-4 class (with HM 1-2 class as the reference, HR=2.65, 95%CI: 1.27-5.53) were risk factors that affect the survival of HM patients (assigned death as 1, survival as 0). Conclusions: HM usually occurs in middle-aged male patients with liver cirrhosis,most commonly affecting both lower limbs. Liver transplantation can control the disease progression to a certain extent. Child-Pugh Class C and HM 3-4 class are risk factors for the prognosis of HM patients.