Clinical features of hepatic myelopathy: An analysis of 562 cases

Mingzhi YANG; Dan WU; Liang TANG; Liangzhi WEN; Dongfeng CHEN; Hongli CUI

doi:10.3969/j.issn.1001-5256.2021.01.023

Volume 37 Issue 1

Jan. 2021

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2021 > 37(1): 115-119

PDF( 2042 KB)

Clinical features of hepatic myelopathy: An analysis of 562 cases

DOI: 10.3969/j.issn.1001-5256.2021.01.023

Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing 400042, China

Received Date: 2020-07-07
Accepted Date: 2020-08-10
Published Date: 2021-01-20

Abstract

Abstract

Objective To investigate the clinical features of patients with hepatic myelopathy (HM) in China. Methods The articles on HM, published in China from January 2009 to December 2018, were collected to analyze the clinical features, laboratory examination results, diagnosis, treatment, and prognosis of HM patients. Results A total of 94 articles were included, with 562 patients in total, among whom there were 489 male patients and 73 female patients. Their age ranged from 17-81 years, with a mean age of 46.3±17.5 years. Hepatitis B cirrhosis was the most common etiology (64.4%), followed by alcoholic cirrhosis (10.3%) and hepatitis C cirrhosis (9.2%). The clinical manifestations of HM mainly included decline of muscle strength (89.50%), tendon hyperreflexia (76.87%), ataxia, and movement disorder (76.51%). Laboratory examination showed an increase in blood ammonia by 92.31% and a reduction in albumin by 88.96%. Imaging diagnosis mainly depended on electromyography (64.92%) and spinal cord MRI (22.82%), and abdominal color Doppler ultrasound, CT, or MRI alone has limited clinical value. After comprehensive medical treatment, no patient (0%) was cured, 106 patients (18.86%) were improved, 211 patients (37.54%) had no response, 31 patients (5.52%) worsened, 129 patients (22.95%) died, and 53 patients (9.43%) were not explained. A total of 39 patients underwent liver transplantation, with an improvement rate of 56.41%. Conclusion HM is a rare complication of end-stage liver disease and is mainly observed in middle-aged men. It has the main manifestation of chronic and progressive spastic paraplegia of both lower limbs. Currently, there is no effective treatment method, and liver transplantation is feasible for some patients, with poor treatment response and poor prognosis.
- Hepatic Myelopathy,
- Liver Cirrhosis,
- Disease Attributes

FullText(HTML)

References(18)

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]	KORI P, SAHU R, JAISWAL A, et al. Hepatic myelopathy: An unusual neurological complication of chronic liver disease presenting as quadriparesis[J]. BMJ Case Rep, 2013, 2013: bcr2013009078. http://casereports.bmj.com/content/2013/bcr-2013-009078
[3]	LI M, WANG ZQ, 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. http://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CJFD&filename=SWYX202001001
[4]	NINAN J, FELDMAN L. Ammonia levels and hepatic encephalopathy in patients with known chronic liver disease[J]. J Hosp Med, 2017, 12(8): 659-661. DOI: 10.12788/jhm.2794
[5]	JAEGER V, DEMORROW S, MCMILLIN M. The direct contribution of astrocytes and microglia to the pathogenesis of hepatic encephalopathy[J]. J Clin Transl Hepatol, 2019, 7(4): 352-361. http://www.ncbi.nlm.nih.gov/pubmed/31915605
[6]	ZHAO H, LIU F, YUE Z, et al. Evaluation of mid- and long-term efficacy of shunt limiting for hepatic myelopathy after transjugular intrahepatic portosystemic shunt[J]. Clin Res Hepatol Gastroenterol, 2016, 40(4): 440-446. DOI: 10.1016/j.clinre.2015.11.004
[7]	LUO SH, CHU JG, HUANG H, et al. Effect of initial stent position on patency of transjugular intrahepatic portosystemic shunt[J]. World J Gastroenterol, 2017, 23(26): 4779-4787. DOI: 10.3748/wjg.v23.i26.4779
[8]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34(10): 2076-2089.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2018.10.007 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34(10) : 2076 -2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007
[9]	HUAN H, TONG H, WEI B, et al. Effect of transjugular intrahepatic portal venous shunt combined with left gastric venous embolization on liver function in patients with cirrhosis[J]. Chin J Dig, 2017, 37(6): 404-410. (in Chinese) DOI: 10.3760/cma.j.issn.0254-1432.2017.06.008 宦徽, 童欢, 魏波, 等. 经颈静脉肝内门体静脉分流术联合胃左静脉栓塞术对肝硬化患者肝功能的影响[J]. 中华消化杂志, 2017, 37(6): 404-410. DOI: 10.3760/cma.j.issn.0254-1432.2017.06.008
[10]	SUN W, LI G, LAI Z, et al. Subacute combined degeneration of the spinal cord and hydrocephalus associated with vitamin B12 deficiency[J]. World Neurosurg, 2019, 128: 277-283. DOI: 10.1016/j.wneu.2019.05.008
[11]	QU B, LIU C, GUO L, et al. The role of liver transplantation in the treatment of hepatic myelopathy: Case report with review of the literature[J]. Transplant Proc, 2009, 41(5): 1987-1989. DOI: 10.1016/j.transproceed.2009.01.105
[12]	WEISSENBORN K, TIETGE UJ, BOKEMEYER M, et al. Liver transplantation improves hepatic myelopathy: Evidence by three cases[J]. Gastroenterology, 2003, 124(2): 346-351. DOI: 10.1053/gast.2003.50062
[13]	TAPIAPEREZ J, VOLL C, SHARARAH S. Treatment of spinal myoclonus due to degenerative compression myelopathy with cervical spinal cord stimulation: A report of 2 cases[J]. World Neurosurgery, 2020, 136: 44-48. DOI: 10.1016/j.wneu.2019.12.170
[14]	CHEN ZH, CHEN DF. Progress of hepatic myelopathy[J]. Chin J Gastroenterol Hepatol, 2016, 25(7): 832-834. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX201607031.htm 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. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX201607031.htm
[15]	WU F, PU CW, ZHANG Y. Efficacy of autologous transplantation of bone marrow derived mesenchymal stem cells in the treatment of decompensated liver cirrhosis[J/CD]. Chin J Liver Dis (Electronic Version), 2015, 7(3): 130-134. (in Chinese) 吴锋, 蒲春文, 张勇. 自体骨髓间充质干细胞移植治疗失代偿期肝硬化的临床疗效观察[J/CD]. 中国肝脏病杂志(电子版), 2015, 7(3): 130-134.
[16]	TSOLAKI E, YANNAKI E. Stem cell-based regenerative opportunities for the liver: State of the art and beyond[J]. World J Gastroenterol, 2015, 21(43): 12334-12350. DOI: 10.3748/wjg.v21.i43.12334
[17]	JU SD, ZONG L. Discussion on acupuncture for flaccid paralysis from "treating flaccid paralysis by yangming alone"[J]. Chin Acupunct Moxibust, 2015, 35(9): 956-959.(in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201509043.htm 鞠申丹, 宗蕾. 从"治痿独取阳明"谈痿证的针灸治疗[J]. 中国针灸, 2015, 35(9): 956-959. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201509043.htm
[18]	GOU CY, QIAN Y, LI JY, et al. Professor Qian Ying's experience in treating hepatic myelopathy with Dihuang Yinzi[J]. Chin J Integr Tradit West Med Liver Dis, 2014, 24(1): 50-51. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201401018.htm 勾春燕, 钱英, 李晶莹, 等. 钱英教授运用地黄饮子治疗肝性脊髓病经验初探[J]. 中西医结合肝病杂志, 2014, 24(1): 50-51. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201401018.htm

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Tables(2)

Get Citation

PDF

XML

Article Metrics

Article views (769) PDF downloads(82)

Clinical features of hepatic myelopathy: An analysis of 562 cases

DOI: 10.3969/j.issn.1001-5256.2021.01.023

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Clinical features of hepatic myelopathy: An analysis of 562 cases

DOI: 10.3969/j.issn.1001-5256.2021.01.023

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content