To analyze the clinical data of 126 patients with hepatic myelopathy （HM），to summarize their clinical manifestations and prognostic features，and to provide a reference for clinical diagnosis and treatment.

Related clinical data were collected from 126 HM patients who attended The First Hospital of Lanzhou University from January 1，2016 to June 30，2025，and according to their muscle strength on admission，they were divided into grade<3 group，grade 3 group，and grade 4 group. The three groups were compared in terms of the clinical data including etiology，symptoms，clinical signs，past history，personal history，laboratory test results，imaging findings，treatment，and outcome. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups，and the least significant difference t-test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups，and the Bonferroni correction method was used for further comparison between two groups； the chi-square test was used for comparison of categorical data between multiple groups.

All 126 patients with HM were comorbid with liver cirrhosis，with a male/female ratio of 2.7∶1，an age of 23 — 73 years，a mean age of 53.9±9.3 years，and a median age of 54 years. The top three etiologies of liver cirrhosis were hepatitis B in 78 patients （61.9%），hepatitis C in 9 patients （7.1%），and alcoholic hepatitis in 8 patients （6.3%）. During the course of the disease，all 126 patients with HM showed weakness in both lower limbs，among whom 9 patients （7.1%） also had the symptoms of lower limb pain and numbness. Among the 126 patients，3 （2.4%） had grade 0 muscle strength，4 （3.2%） had grade 1 muscle strength，9 （7.1%） had grade 2 muscle strength，39 （31.0%） had grade 3 muscle strength，and 71 （56.3%） had grade 4 muscle strength. Comparison of related data between the three groups of patients with varying grades of muscle strength showed that as for comorbidities，there were significant differences between the three groups in the constituent ratios of overt hepatic encephalopathy （OHE） （χ²=6.254，P=0.044），ascites （χ²=6.248，P=0.044），and liver failure （χ²=7.704，P=0.029）； as for laboratory markers，there were significant differences between the three groups in red blood cell count （RBC） （F=5.334，P=0.006），hemoglobin （HGB） （F=4.627，P=0.012），aspartate aminotransferase （AST） （H=6.866，P=0.032），alanine aminotransferase （H=6.444，P=0.040），albumin （Alb） （F=6.331，P=0.002），cholinesterase （ChE） （H=11.064，P=0.004），total cholesterol （TC） （F=4.843，P=0.009），prothrombin activity （PTA） （F=3.937，P=0.022） and international normalized ratio （INR） （H=6.448，P=0.040）. Compared with the grade 4 group，the grade<3 group had significantly lower levels of RBC，HGB，and ChE （all P<0.05） and a significantly higher level of AST （P<0.05）； compared with the grade 3 group，the grade<3 group had significant reductions in Alb，TC，and PTA （all P<0.05） and a significant increase in INR （P<0.05）. At discharge，27 patients （21.4%） achieved improvement，and 99 patients （78.6%） showed no response，among whom 2 patients died.

HM has the main clinical manifestation of symmetrical spastic paraplegia of both lower limbs，and it is more common in men. The main causes of HM include hepatitis B，hepatitis C，and alcoholic hepatitis. Muscle strength in HM patients is associated with the comorbidity of OHE，ascites，or liver failure，and patients with weak muscle strength tend to have low levels of RBC，HGB，Alb，ChE，TC，and PTA and high levels of AST and INR，suggesting that the changes in these indicators may be correlated with the degree of muscle strength impairment. HM often has a poor prognosis，and there are currently no effective treatment methods.