Body composition changes after transjugular intrahepatic portosystemic shunt in patients with cirrhosis

作者：Montomoli Jonathan; Holland Fischer Peter; Bianchi Giampaolo^*; Gronbaek Henning; Vilstrup Hendrik; Marchesini Giulio; Zoli Marco

来源：World Journal of Gastroenterology, 2010, 16(3): 348-353.

DOI：10.3748/wjg.v16.i3.348

• Insulin resistance
• Liver cirrhosis
• Malnutrition
• Portal hypertension
• Transjugular intrahepatic porto-systemic shunt

AIM: To investigate the effect of transjugular intrahepatic porto-systemic shunt (TIPS) on malnutrition in portal hypertensive cirrhotic patients.
METHODS: Twenty-one patients with liver cirrhosis and clinical indications for TIPS insertion were investigated before and 1, 4, 12, 52 wk after TIPS. For each patient we assayed body composition parameters [dry lean mass, fat mass, total body water (TBW)], routine liver and kidney function tests, and free fatty acids (FFA). Glucose and insulin were measured for the calculation of the homeostasis model assessment insulin resistance (HOMA-IR); liver function was measured by the galactose elimination capacity (GEC); the severity of liver disease was graded by model for end-stage liver disease (MELD).
RESULTS: Porto-systemic gradient decreased after TIPS (6.0 +/- 2.1 mmHg vs 15.8 +/- 4.8 mmHg, P < 0.001). Patients were divided in two groups according to initial body mass index. After TIPS, normal weight patients had an increase in dry lean mass (from 10.9 +/- 5.9 kg to 12.7 +/- 5.6 kg, P = 0.031) and TBW (from 34.5 +/- 7.6 L to 40.2 +/- 10.8 L, P = 0.007), as well as insulin (from 88.9 +/- 49.2 pmol/L to 164.7 +/- 107.0 pmol/L, P = 0.009) and HOMA-IR (from 3.36% +/- 2.18% to 6.18% +/- 4.82%, P = 0.023). In overweight patients only FFA increased significantly (from 0.59 +/- 0.24 mmol/L to 0.93 +/- 0.34 mmol/L, P = 0.023).
CONCLUSION: TIPS procedure is effective in lowering portal pressure in patients with portal hypertension and improves body composition without significant changes in metabolic parameters.

• 出版日期2010-1-21