Probiotics Prevent Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt: A Randomised Controlled Trial

IF 5.2 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-08-12 DOI:10.1111/liv.70289

Xin Quan, Ying Li, Xiuling Ye, Bo Wei, Yang Tai, Shuaijie Qian, Zhidong Wang, Linhao Zhang, Xu Guo, Huan Tong, Hao Wu

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引用次数: 0

Abstract

Background and Aims

Hepatic encephalopathy (HE) is the most common complication of cirrhosis after transjugular intrahepatic portosystemic shunt (TIPS) and is closely related to intestinal dysbiosis. The efficacy of probiotics in improving minimal HE (MHE) has been well studied, while the role of probiotics for the primary prophylaxis of overt HE (OHE) after TIPS has not been established. We aimed to determine whether Live Combined Bifidobacterium and Lactobacillus Tablets, a commonly used probiotic preparation in China, reduced the risk of post-TIPS HE.

Method

We conducted an open-label, randomised, blank-controlled trial of 142 patients with cirrhosis receiving TIPS. Patients were randomly assigned to receive probiotics (2 g three times daily) or not. The primary outcome was the incidence of OHE within 24 weeks after TIPS. The secondary outcomes were improvement in cognitive function [defined by the number connection test-A (NCT-A) and digit symbol test (DST)] and the incidence of other cirrhosis-related complications at 24 weeks.

Results

The incidence of post-TIPS OHE was 51.4% in the control group (n = 70), which was significantly lower in the probiotics group (n = 72, 36.1%, Fine-Grey p = 0.043). In the subgroup of patients without post-TIPS OHE, liver transplantation or death, there was no significant difference in DST and NCT-A tests at 24 weeks compared with baseline in the control group. By contrast, both DST [31.5 (26.4–39.3) vs. 34.5 (29.8–43.0), p < 0.0001] and NCT-A [53.8 (43.3–71.2) vs. 46.6 (40.2–64.4), p = 0.0045] significantly improved at 24 weeks in the probiotics group. There was no significant difference in other cirrhosis-related complications between the two groups.

Conclusion

Live Combined Bifidobacterium and Lactobacillus Tablets might reduce the risk of OHE and improve cognitive function in cirrhosis patients receiving TIPS for variceal bleeding without previous OHE. Multicenter studies should be performed to provide further evidence.

Trial Registration: Chictr.org: ChiCTR2200062996.

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益生菌预防经颈静脉肝内门静脉系统分流术后肝性脑病：一项随机对照试验

背景与目的肝性脑病（HE）是经颈静脉肝内门系统分流术（TIPS）后肝硬化最常见的并发症，与肠道生态失调密切相关。益生菌在改善最低HE （MHE）方面的功效已经得到了很好的研究，而益生菌在TIPS后显性HE （OHE）的初级预防中的作用尚未确定。我们的目的是确定双歧杆菌联合乳杆菌活片（一种中国常用的益生菌制剂）是否能降低tips后HE的风险。方法我们对142例接受TIPS治疗的肝硬化患者进行了一项开放标签、随机、空白对照试验。患者被随机分配接受或不接受益生菌（每天3次，每次2克）。主要终点是TIPS后24周内OHE的发生率。次要结果是认知功能的改善[由数字连接测试- a （NCT-A）和数字符号测试（DST）定义]和24周时其他肝硬化相关并发症的发生率。结果对照组tips后OHE发生率为51.4% (n = 70)，益生菌组显著低于对照组（n = 72, 36.1%, Fine-Grey p = 0.043）。在未发生tips后OHE、肝移植或死亡的患者亚组中，与对照组基线相比，24周时DST和NCT-A检测无显著差异。相比之下，益生菌组的DST [31.5 (26.4-39.3) vs. 34.5 (29.8-43.0), p <； 0.0001]和NCT-A [53.8 (43.3-71.2) vs. 46.6 (40.2-64.4), p = 0.0045]在24周时均显著改善。两组间其他肝硬化相关并发症无显著差异。结论双歧杆菌联合乳杆菌活片可降低无OHE的肝硬化患者静脉曲张出血提示患者发生OHE的风险，改善认知功能。应进行多中心研究以提供进一步的证据。试验注册：Chictr.org: ChiCTR2200062996。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.