Cirrhosis, Hypersplenism, Lipid Profiles, Splenectomy; Status
Conditions
Keywords
Cirrhosis, Splenectomy, Laparoscopy, Lipid Profiles, Hypersplenism, portal hypertension
Brief summary
Patients with liver cirrhosis frequently exhibit dyslipidemia due to impaired hepatic lipid synthesis, altered bile acid metabolism, and portal hypertension. Laparoscopic splenectomy is commonly used to treat splenomegaly and hypersplenism in these patients, but its impact on lipid profiles over 2 years remains poorly characterized. This study will follow patients undergoing laparoscopic splenectomy to measure changes in serum lipid parameters before and after surgery, identify risk factors for lipid profile deterioration or improvement, and determine whether laparoscopic splenectomy can ameliorate dyslipidemia in the long term, thereby informing metabolic management strategies in cirrhotic patients.
Detailed description
Rationale: Liver cirrhosis disrupts hepatic lipid homeostasis through multiple mechanisms, including decreased apolipoprotein synthesis, impaired cholesterol esterification, and altered very-low-density lipoprotein (VLDL) secretion, resulting in characteristic lipid abnormalities such as hypocholesterolemia and low high-density lipoprotein cholesterol (HDL-C). Hypersplenism further complicates this metabolic profile through increased lipid peroxidation and inflammatory cytokine-mediated dysregulation of lipid metabolism. Laparoscopic splenectomy (LS) reduces splenic sequestration and inflammatory burden, potentially improving hepatic lipid synthetic capacity and peripheral lipid clearance. However, perioperative stress responses, anesthetic effects, and abrupt hemodynamic changes may transiently worsen lipid profiles. Current evidence lacks prospective, 2-year data on lipid profile dynamics after LS in this population, particularly regarding the trajectory of total cholesterol, triglycerides, LDL-C, HDL-C. This study aims to fill this gap to guide perioperative metabolic monitoring and long-term dyslipidemia management. Study Design: Prospective, single-center, observational cohort study with a total duration of 24 months (2 years). Patients with cirrhosis, splenomegaly and hypersplenism scheduled for elective laparoscopic splenectomy will be enrolled and followed for 2 years to assess lipid profile dynamics and identify risk factors for metabolic deterioration or improvement. Study Timeline: Months 1-6: Patient screening, enrollment, baseline lipid assessment Months 1-18: Laparoscopic splenectomy and perioperative short-term lipid monitoring Months 7-24: Long-term follow-up at 3, 6, 9,12, 24 months postoperatively Month 24: Data analysis and study completion
Interventions
None listed
Sponsors
Northern Jiangsu People's Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-80 years, male or female 2. Confirmed diagnosis of liver cirrhosis (clinical, laboratory, imaging) 3. Splenomegaly and hypersplenism 4. Child-Pugh Class A or B liver function 5. Signed written informed consent 6. Ability to complete 24-month follow-up
Exclusion criteria
1. Child-Pugh Class C liver cirrhosis 2. No history of portal hypertension bleeding (esophageal and gastric variceal bleeding ) 3. Previous abdominal surgery precluding safe laparoscopic splenectomy. 4. Severe cardiac, pulmonary, cerebrovascular dysfunction; malignant tumors; primary hematological disorders 5. Metabolic/endocrine diseases: Familial hyperlipidemia; uncontrolled severe diabetes mellitus, thyroid dysfunction, nephrotic syndrome; use of lipid-lowering drugs, hormones, or other drugs affecting blood lipids within 1 month before surgery. 6. Infections/inflammatory diseases: Active hepatitis, severe infections, or autoimmune diseases. 7. Cirrhotic complications (hepatic encephalopathy, refractory ascites) within 1 month before surgery 8. Pregnancy or lactation 9. Poor compliance, inability to complete follow-up
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total cholesterol (TC) level | at preoperative baseline, postoperative month 1, month 3, month 6, month 12, month 18, month 24 | Change in total cholesterol (TC) level |
| Total triglycerides (TG) level | at preoperative baseline, postoperative month 1, month 3, month 6, month 12, month 18, month 24 | Change in total triglycerides (TG) level |
| High-density lipoprotein cholesterol (HDL-C) level | at preoperative baseline, postoperative month 1, month 3, month 6, month 12, month 18, month 24 | Change in high-density lipoprotein cholesterol (HDL-C) |
| Low-density lipoprotein cholesterol (LDL-C) level | at preoperative baseline, postoperative month 1, month 3, month 6, month 12, month 18, month 24 | Change in low-density lipoprotein cholesterol (LDL-C) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative variables | During the procedure of operation | operation time, intraoperative blood loss, fluid infusion, mean arterial pressure |
| Postoperative complications | at preoperative baseline, postoperative month 1, month 3, month 6, month 12, month 18, month 24 | postoperative complications (bleeding, infection, hepatic encephalopathy, ascites) |
| Albumin, bilirubin | at preoperative baseline, postoperative month 1, month 3, month 6, month 12, month 18, month 24 | Changes in albumin, bilirubin |
| Child-Pugh grade | at preoperative baseline, postoperative month 1, month 3, month 6, month 12, month 18, month 24 | Changes in Child-Pugh grade The Child-Pugh score is calculated based on five parameters, each assigned 1, 2, or 3 points. 1. Total bilirubin * Less than 2 mg/dL: 1 point * 2-3 mg/dL: 2 points * Greater than 3 mg/dL: 3 points 2. Serum albumin * Greater than 3.5 g/dL: 1 point * 2.8-3.5 g/dL: 2 points * Less than 2.8 g/dL: 3 points 3. Prothrombin time prolongation or INR * Prolongation less than 4 seconds (INR \< 1.7): 1 point * Prolongation 4-6 seconds (INR 1.7-2.3): 2 points * Prolongation greater than 6 seconds (INR \> 2.3): 3 points 4. Ascites * None: 1 point * Mild or controlled with diuretics: 2 points * Moderate to severe or refractory: 3 points 5. Hepatic encephalopathy * None: 1 point * Grade I-II: 2 points * Grade III-IV: 3 points Total score and corresponding grade * 5-6 points: Child-Pugh class A * 7-9 points: Child-Pugh class B * 10-15 points: Child-Pugh class C |
Countries
China
Contacts
CONTACTGuo-Qing Jiang, MD
CONTACTDou-Sheng Bai, MD
STUDY_CHAIRGuo-Qing Jiang, MD
Clinical Medical College of Yangzhou University
Outcome results
None listed