脾切除术对肝豆状核变性合并脾功能亢进患者神经功能、预后的影响

摘要/Abstract

摘要： 目的探讨脾切除术对肝豆状核变性合并脾功能亢进患者神经功能、预后的影响,为该类患者的诊治提供依据。方法纳入2020年1月至2023年3月期间入院诊治肝豆状核变性合并脾功能亢进的患者63例,根据患者入院后是否接受脾切除术治疗,将患者分为脾切除术组(n=32)和非脾切除术组(n=31)。比较两组患者基线资料、治疗后神经功能和治疗后肝功能水平。结果两组患者基线资料的差异不具有统计学意义(P>0.05)。脾切除术组患者治疗后运动功能异常占比、精神状态异常占比和神经影像学检查异常占比分别为6.3%、3.1%和3.1%,显著低于非脾切除术组患者[19.4%、12.9%和16.1%,均P<0.05]。脾切除术组患者治疗后Child-Pugh A级占比为81.3%,显著大于非脾切除术组患者(48.4%),治疗后Child-Pugh B级占比、ALT水平、AST水平和ALP水平分别为6.3%、65(6,107)U/L、48(3,89)U/L和90(57,126)U/L,显著低于非脾切除术组患者[22.6%、136(13,546)U/L、94(32,637)U/L和120(70,382)U/L,均P<0.05]。预后方面,脾切除术组有2例患者死亡,非脾切除术组有6例患者死亡。结论脾切除术可以明显改善肝豆状核变性合并脾功能亢进患者的神经功能和预后。

关键词: 脾切除术, 肝豆状核变性, 脾功能亢进

Abstract: Objective To explore the impact of splenectomy on neurological function and prognosis in patients with hepatolenticular degeneration and hypersplenism, and to provide a basis for the management of patients with hepatolenticular degeneration and hypersplenism. Methods From January 2020 to March 2023, 63 patients with hepatolenticular degeneration and hypersplenism were admitted to the hospital. According to whether the patients received splenectomy treatment after admission, the patients were divided into a splenectomy group (n=32) and a non-splenectomy group (n=31). The baseline data, post-treatment neurological function and post-treatment liver function of the two groups were compared. Results The difference in the baseline data of the two groups is not statistically significant (P>0.05).The proportion of abnormal motor function and mental function of the patients in the splenectomy group after treatment were 6.3%, 3.1% and 3.1% respectively, which were significantly lower than those of patients in the non-splenectomy group [19.4%, 12.9% and 16.1% (P<0.05)]. The proportion of Child-Pugh A grade after treatment in the splenectomy group was 81.3%, which was significantly higher than that of the patients in the non-splenectomy group (48.4%). The proportion of Child-Pugh grade B, ALT level, and AST level after treatment were and ALP levels were 6.3%, 65 (6,107) U/L, 48 (3,89) U/L and 90 (57,126) U/L respectively, which were significantly lower than those in the non-splenectomy group [22.6%, 136 (13,546) U/L, 94 (32,637) U/L and 120 (70,382) U/L(P<0.05)].In terms of prognosis, 2 patients died in the splenectomy group and 6 patients died in the non-splenectomy group. Conclusion Splenectomy can significantly improve splenic function, neurological function and prognostic outcomes in hepatolenticular degeneration.

Key words: Splenectomy, Hepatolenticular degeneration, Hypersplenism

赵广龙, 胡明, 王晓东. 脾切除术对肝豆状核变性合并脾功能亢进患者神经功能、预后的影响[J]. 肝脏, 2026, 31(3): 424-427.

ZHAO Guang-long, HU Ming, WANG Xiao-dong. Effect of splenectomy on neurological function and prognosis in patients with hepatolenticular degeneration and hypersplenism[J]. Chinese Hepatolgy, 2026, 31(3): 424-427.

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