Clinical features of hepatic myelopathy: An analysis of 126 cases

Xiaofang Wang; Zibing Qian; Ziyi Li; Xiaorong Mao

doi:10.12449/JCH260821

Volume 42 Issue 8

Aug. 2026

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Article Navigation > Journal of Clinical Hepatology > 2026 > 42(8): 1888-1893

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Clinical features of hepatic myelopathy: An analysis of 126 cases

DOI: 10.12449/JCH260821

1.
The First Clinical Medical College of Lanzhou University，Lanzhou 730000，China
2.
Department of Infectious Diseases，The First Hospital of Lanzhou University，Lanzhou 730000，China

Research funding:

Key Research and Development Program of Gansu Province (24YFFA037);

Key Research and Development Program of Gansu Province (25YFFA048);

Science and Technology Plan of Lanzhou (2023-ZD-105)

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Corresponding author: Mao Xiaorong， maoxr@lzu.edu.cn （ORCID： 0000-0003-1952-1554）
Received Date: 2026-02-10
Accepted Date: 2026-03-19
Published Date: 2026-08-25

Abstract

Abstract

Objective To analyze the clinical data of 126 patients with hepatic myelopathy （HM）， to summarize their clinical manifestations and prognostic features， and to provide a reference for clinical diagnosis and treatment. Methods Related clinical data were collected from 126 HM patients who attended The First Hospital of Lanzhou University from January 1， 2016 to June 30， 2025， and according to their muscle strength on admission， they were divided into grade<3 group， grade 3 group， and grade 4 group. The three groups were compared in terms of the clinical data including etiology， symptoms， clinical signs， past history， personal history， laboratory test results， imaging findings， treatment， and outcome. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups， and the Bonferroni correction method was used for further comparison between two groups； the chi-square test was used for comparison of categorical data between multiple groups. Results All 126 patients with HM were comorbid with liver cirrhosis， with a male/female ratio of 2.7∶1， an age of 23 — 73 years， a mean age of 53.9±9.3 years， and a median age of 54 years. The top three etiologies of liver cirrhosis were hepatitis B in 78 patients （61.9%）， hepatitis C in 9 patients （7.1%）， and alcoholic hepatitis in 8 patients （6.3%）. During the course of the disease， all 126 patients with HM showed weakness in both lower limbs， among whom 9 patients （7.1%） also had the symptoms of lower limb pain and numbness. Among the 126 patients， 3 （2.4%） had grade 0 muscle strength， 4 （3.2%） had grade 1 muscle strength， 9 （7.1%） had grade 2 muscle strength， 39 （31.0%） had grade 3 muscle strength， and 71 （56.3%） had grade 4 muscle strength. Comparison of related data between the three groups of patients with varying grades of muscle strength showed that as for comorbidities， there were significant differences between the three groups in the constituent ratios of overt hepatic encephalopathy （OHE）（χ²=6.254， P=0.044）， ascites （χ²=6.248， P=0.044）， and liver failure （χ²=7.704， P=0.029）； as for laboratory markers， there were significant differences between the three groups in red blood cell count （RBC）（F=5.334， P=0.006）， hemoglobin （HGB）（F=4.627， P=0.012）， aspartate aminotransferase （AST）（H=6.866， P=0.032）， alanine aminotransferase （H=6.444， P=0.040）， albumin （Alb）（F=6.331， P=0.002）， cholinesterase （ChE）（H=11.064， P=0.004）， total cholesterol （TC）（F=4.843， P=0.009）， prothrombin activity （PTA）（F=3.937， P=0.022） and international normalized ratio （INR）（H=6.448， P=0.040）. Compared with the grade 4 group， the grade<3 group had significantly lower levels of RBC， HGB， and ChE （all P<0.05） and a significantly higher level of AST （P<0.05）； compared with the grade 3 group， the grade<3 group had significant reductions in Alb， TC， and PTA （all P<0.05） and a significant increase in INR （P<0.05）. At discharge， 27 patients （21.4%） achieved improvement， and 99 patients （78.6%） showed no response， among whom 2 patients died. Conclusion HM has the main clinical manifestation of symmetrical spastic paraplegia of both lower limbs， and it is more common in men. The main causes of HM include hepatitis B， hepatitis C， and alcoholic hepatitis. Muscle strength in HM patients is associated with the comorbidity of OHE， ascites， or liver failure， and patients with weak muscle strength tend to have low levels of RBC， HGB， Alb， ChE， TC， and PTA and high levels of AST and INR， suggesting that the changes in these indicators may be correlated with the degree of muscle strength impairment. HM often has a poor prognosis， and there are currently no effective treatment methods.
- Hepatic Myelopathy,
- Liver Cirrhosis,
- Signs and Symptoms

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References

[1]	Utku U, Asil T, Balci K, et al. Hepatic myelopathy with spastic paraparesis[J]. Clin Neurol Neurosurg, 2005, 107( 6): 514- 516. DOI: 10.1016/j.clineuro.2004.10.002.
[2]	Conn H O, Rössle M, Levy L, et al. Portosystemic myelopathy: Spastic paraparesis after portosystemic shunting[J]. Scand J Gastroenterol, 2006, 41( 5): 619- 625. DOI: 10.1080/00365520500318932.
[3]	Ma Fuquan, Huang Jin, Li Weizhi, et al. Effects of reduced portosystemic flow on hepatic myelopathy in patients with cirrhosis after TIPS[J]. Chin J Hepatol, 2022, 30( 10): 1063- 1068. DOI: 10.3760/cma.j.cn501113-20201026-00580. 马富权, 黄金, 李伟之, 等. 减少门腔分流量对肝硬化患者经颈静脉肝内门体分流术后肝性脊髓病的影响[J]. 中华肝脏病杂志, 2022, 30( 10): 1063- 1068. DOI: 10.3760/cma.j.cn501113-20201026-00580.
[4]	Nardone R, Höller Y, Storti M, et al. Spinal cord involvement in patients with cirrhosis[J]. World J Gastroenterol, 2014, 20( 10): 2578- 2585. DOI: 10.3748/wjg.v20.i10.2578.
[5]	Kroupina K, Bémeur C, Rose C F. Amino acids, ammonia, and hepatic encephalopathy[J]. Anal Biochem, 2022, 649: 114696. DOI: 10.1016/j.ab.2022.114696.
[6]	Li M, Wang Z Q, Zhang L, et al. Burden of cirrhosis and other chronic liver diseases caused by specific etiologies in China, 1990-2016: Findings from the global burden of disease study 2016[J]. Biomed Environ Sci, 2020, 33( 1): 1- 10. DOI: 10.3967/bes2020.001.
[7]	Haj M, Rockey D C. Ammonia levels do not guide clinical management of patients with hepatic encephalopathy caused by cirrhosis[J]. Am J Gastroenterol, 2020, 115( 5): 723- 728. DOI: 10.14309/ajg.0000000000000343.
[8]	Chen Zhihui, Chen Dongfeng. Progress of hepatic myelopathy[J]. Chin J Gastroenterol Hepatol, 2016, 25( 7): 832- 834. DOI: 10.3969/j.issn.1006-5709.2016.07.028. 陈志惠, 陈东风. 肝性脊髓病研究进展[J]. 胃肠病学和肝病学杂志, 2016, 25( 7): 832- 834. DOI: 10.3969/j.issn.1006-5709.2016.07.028.
[9]	Huang Jin, Xue Hui, Ma Fuquan. Research progress of hepatic myelopathy[J]. Mod Dig Interv, 2024, 29( 8): 1011- 1014. DOI: 10.3969/j.issn.1672-2159.2024.08.027. 黄金, 薛挥, 马富权. 肝性脊髓病的研究进展[J]. 现代消化及介入诊疗, 2024, 29( 8): 1011- 1014. DOI: 10.3969/j.issn.1672-2159.2024.08.027.
[10]	Wang M Q, Dake M D, Cui Z P, et al. Portal-systemic myelopathy after transjugular intrahepatic portosystemic shunt creation: Report of four cases[J]. J Vasc Interv Radiol, 2001, 12( 7): 879- 881. DOI: 10.1016/s1051-0443(07)61514-0.
[11]	Sureka B, Bansal K, Patidar Y, et al. Neurologic manifestations of chronic liver disease and liver cirrhosis[J]. Curr Probl Diagn Radiol, 2015, 44( 5): 449- 461. DOI: 10.1067/j.cpradiol.2015.03.004.
[12]	Baltrusch S. The role of neurotropic B vitamins in nerve regeneration[J]. Biomed Res Int, 2021, 2021: 9968228. DOI: 10.1155/2021/9968228.
[13]	Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006. 中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
[14]	Caldwell C, Werdiger N, Jakab S, et al. Use of model for end-stage liver disease exception points for early liver transplantation and successful reversal of hepatic myelopathy with a review of the literature[J]. Liver Transplant, 2010, 16( 7): 818- 826. DOI: 10.1002/lt.22077.
[15]	Koul R, Lal B B, Pamecha V, et al. Liver transplantation reverses hepatic myelopathy in 2 children with hepatitis A infection[J]. Child Neurol Open, 2021, 8: 2329048 X 20983763. DOI: 10.1177/2329048X20983763.
[16]	Li Huiwen, Xu Yubo, Xu Zehua, et al. Treating hepatic myelopathy with chronic and acute liver failure caused by stopping antiviral drugs by acupuncture[J]. Clin J Chin Med, 2022, 14( 35): 53- 56. DOI: 10.3969/j.issn.1674-7860.2022.35.015. 李惠文, 许钰波, 许泽华, 等. 针刺治疗停抗病毒药致肝性脊髓病截瘫伴慢加急性肝衰竭案[J]. 中医临床研究, 2022, 14( 35): 53- 56. DOI: 10.3969/j.issn.1674-7860.2022.35.015.
[17]	Xu Yubo, Li Yuewei, Li Chengyu. One case of end-stage complications of hepatic myelopathy by Qi-acupuncture of the TCM plus medicine[J]. Clin J Chin Med, 2021, 13( 23): 56- 58. DOI: 10.3969/j.issn.1674-7860.2021.23.018. 许钰波, 李月伟, 李成玉. 中医气针疗法配合药物治疗肝性脊髓病终末期多并发症1例[J]. 中医临床研究, 2021, 13( 23): 56- 58. DOI: 10.3969/j.issn.1674-7860.2021.23.018.
[18]	Smith M L, Wade J B, Wolstenholme J, et al. Gut microbiome-brain-cirrhosis axis[J]. Hepatology, 2024, 80( 2): 465- 485. DOI: 10.1097/HEP.0000000000000344.

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Clinical features of hepatic myelopathy: An analysis of 126 cases

DOI: 10.12449/JCH260821

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