Barron H V, Alam I, Lesh M D, Strunk A, Bass N M
Department of Cardiology and The Liver Center, University of California, San Francisco, USA.
Am J Gastroenterol. 1999 Apr;94(4):986-9. doi: 10.1111/j.1572-0241.1999.01000.x.
Chronic liver disease is often associated with impairment of autonomic nervous system (ANS) reflexes. Baroreflex sensitivity (BRS) testing is an inexpensive, relatively noninvasive test that can be used to assess ANS tone. The aims of the present study were to determine the prevalence of ANS dysfunction in cirrhotics who are being considered for liver transplantation and to explore the potential use of BRS as a prognostic tool in identifying patients awaiting transplantation who are at increased risk for death.
We studied nine cirrhotics who were awaiting liver transplantation and seven controls without liver disease. BRS (ms/mm Hg) was measured using the phenylephrine method.
BRS (mean +/- SEM) (ms/mm Hg) was significantly lower in cirrhotics compared with controls (4.2 +/- 0.9 vs 21.1 +/- 3.8 ms/mm Hg; p < 0.05). Furthermore, BRS was lower in cirrhotics with hepatic encephalopathy compared with those without (2.6 +/- 0.9 vs 6.1 +/- 1.0 ms/mm Hg; p < 0.05) and there was a trend toward lower BRS values in Child-Pugh class C patients as compared with class B (3.8 +/- 1.3 vs 5.3 +/- 1.2 ms/mm Hg; p = 0.3). At follow-up (9 months), one patient had died and one underwent liver transplantation. These two patients also had the most severely impaired vagal tone (BRS = 0 and 1.2 ms/mm Hg, respectively).
Vagal tone, as assessed by BRS, is markedly depressed in cirrhotic patients awaiting liver transplantation.
慢性肝病常与自主神经系统（ANS）反射受损有关。压力反射敏感性（BRS）测试是一种廉价且相对无创的测试，可用于评估ANS张力。本研究的目的是确定正在考虑进行肝移植的肝硬化患者中ANS功能障碍的患病率，并探讨BRS作为一种预后工具在识别等待移植且死亡风险增加的患者中的潜在用途。
我们研究了9名等待肝移植的肝硬化患者和7名无肝病的对照者。使用去氧肾上腺素法测量BRS（毫秒/毫米汞柱）。
与对照组相比，肝硬化患者的BRS（平均值±标准误）（毫秒/毫米汞柱）显著降低（4.2±0.9 vs 21.1±3.8毫秒/毫米汞柱；p<0.05）。此外，与无肝性脑病的肝硬化患者相比，有肝性脑病的患者BRS更低（2.6±0.9 vs 6.1±1.0毫秒/毫米汞柱；p<0.05），并且Child-Pugh C级患者的BRS值与B级患者相比有降低趋势（3.8±1.3 vs 5.3±1.2毫秒/毫米汞柱；p = 0.3）。在随访（9个月）时，1例患者死亡，1例接受了肝移植。这两名患者的迷走神经张力也受损最严重（BRS分别为0和1.2毫秒/毫米汞柱）。
通过BRS评估的迷走神经张力在等待肝移植的肝硬化患者中明显降低。
