Handgrip Strength, Transjugular Intrahepatic Portosystemic Shunts (TIPS)
Conditions
Brief summary
1.Background Handgrip strength , a core indicator of muscle function, has been confirmed to be significantly associated with the clinical prognosis of patients with liver cirrhosis. However, no studies have explored its correlation with portal venous hemodynamics. 2. Objective The purpose of the study is to examine the effects of Handgrip strength on portal vein and left gastric vein pressure, blood flow velocity and direction in patients with liver cirrhosis. 3\. Method: observational study. Detection Timing: Doppler ultrasound was employed to determine the portal flow velocity and direction at baseline and during the handgrip strength test in cirrhotic patients with a history of variceal bleeding. Three days later, prior to TIPS placement, the pressures in the portal pressure and gastric vein pressure were measured both before and after handgrip strength. Furthermore, carvedilol and vasoactive drugs were discontinued three days before the study commenced. 4. Elaboration of the Research Hypothesis 4.1. Core Hypothesis The handgrip strength level in patients with liver cirrhosis is correlated with portal venous system hemodynamic indices. Specifically, enhanced handgrip strength may affect portal hypertension and the hemodynamics of varicose veins by improving systemic muscle function or circulatory status. 4.2. Speculation on potential mechanisms Association between muscle function and circulation: As a representative of systemic muscle function, increased handgrip strength may reflect an increase in cardiac output or changes in splanchnic vascular resistance, thereby influencing portal venous hemodynamics.
Interventions
DEVICEHandgrip strength
Jamar Hand Dynamometer, from Illinois, USA. Maximum handgrip strength was measured three times, with each measurement lasting 3 seconds and a 1-minute interval between tests
Sponsors
Shanxi Provincial People's Hospital
The First Affiliated Hospital of Henan University of Science and Technology
Study design
Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* adult patients (≥18 years of age) with cirrhosis and a history of variceal bleeding, who were preparing for TIPS creation for secondary prophylaxis against variceal bleeding
Exclusion criteria
* Severe congestive heart failure, or severe untreated valvular heart disease * Moderate to severe pulmonary hypertension * Uncontrolled systemic infection * Lesions (e.g., cysts) or tumors in the liver parenchyma that preclude TIPS creation * Overt hepatic encephalopathy * Unrelieved biliary obstruction * Child-Pugh score \> 13 * Model for end-stage liver disease (MELD) score \> 18 * International normalized ratio (INR) \> 5 * Platelet count \< 20×109/mm3 * Participants who had undergone hand or wrist surgery within the previous 3 months or were unable to hold the dynamometer with the testing hand were excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| portal pressure | through study completion, an average of 5 minutes | Prior to TIPS, the pressure monitoring catheter was connected to the pressure-measuring device. Subsequently, the pressures in both the portal vein and left gastric vein were measured simultaneously at baseline and during the handgrip strength test. |
| left gastric vein pressure | through study completion, an average of 5 minutes | Prior to TIPS, the pressure monitoring catheter was connected to the pressure-measuring device. Subsequently, the pressures in both the portal vein and left gastric vein were measured simultaneously at baseline and during the handgrip strength test. |
| portal flow velocity | At least 72 hours after the baseline handgrip strength and during the handgrip strength phase, measurements were conducted at intervals of 15 seconds, 30 seconds, 45 seconds, and 60 seconds after the release of strength related to the handgrip Strength | — |
| Portal vein blood flow direction | At least 72 hours after the baseline handgrip strength and during the handgrip strength phase, measurements were conducted at intervals of 15 seconds, 30 seconds, 45 seconds, and 60 seconds after the release of strength related to the handgrip Strength | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Serum albumin (g / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| alanine aminotransferase(IU / L) | Baseline | Pre-TIPS baseline characteristics, date (n=32) |
| aspartate aminotransferase (IU / L) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Total bilirubin (µmol / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Prothrombin time (second) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Fasting blood glucose (mmol / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| triglyceride (mmol / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Total cholesterol (mmol / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Serum creatinine (µmol / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Serum potassium (mmol / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Serum sodium (mmol / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Serum chloride (mmol / l) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| Platelet count (× 109 / mm3) | Baseline | Pre-TIPS baseline characteristics ,date (n=32) |
| height | Baseline | — |
| weight | Baseline | — |
| Model for end-stage liver disease score | Baseline | Model for end-stage liver disease score: 6-40, the higher scores mean a worse outcome. |
| Child-Pugh score | Baseline | Child-Pugh score: 5-15, the higher scores mean a worse outcome |
| Esophageal varices before endoscopic treatment | Baseline | The diagnosis of esophageal varices and variceal bleeding in patients is confirmed by upper gastrointestinal endoscopy. |
| Collateral vessels before TIPS placement | Baseline | Vascular angiography was performed prior to TIPS placement to diagnose collateral circulation. date (n=32) |
| Ascites | Baseline | Prior to TIPS, ascites was evaluated by ultrasound in 32 patients with liver cirrhosis. |
| Prior overt hepatic encephalopathy | Baseline | — |
| Etiology of cirrhosis | Baseline | — |
| Age | Baseline | — |
| Sex | Baseline | — |
| Handgrip Strength | Baseline | — |
Countries
China
Contacts
CONTACTMingyuan Zhao, M.D.
Outcome results
None listed