Chaudhry V, Corse A M, O'Brian R, Cornblath D R, Klein A S, Thuluvath P J
Department of Neurology,The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Hepatology. 1999 Jun;29(6):1698-703. doi: 10.1002/hep.510290630.
Peripheral neuropathy has been reported in association with chronic liver disease. However, the precise incidence, severity and characteristics of neuropathy, and the relationship of neuropathy to different etiologies of liver disease have not been defined. In this study, 58 patients with advanced liver disease were evaluated in detail for the presence of neuropathy. Peripheral (sensorimotor) neuropathy was found in 71% and autonomic neuropathy was found in 48% of the patients. Although the majority of patients were asymptomatic, neurological examination showed distal sensory loss to pain, or vibration or distal loss of reflexes in 17 patients (29%). Sensory neuropathy was seen more commonly than motor axonal polyneuropathy on nerve conduction studies. Quantitative sensory testing was frequently abnormal (62%) and cooling thresholds were more affected than vibration thresholds. Overall, the pattern of neuropathy in patients with liver disease conformed to the pattern expected in "dying back" or length-dependent neuropathy. The neuropathy was most severe in patients with advanced hepatic decompensation. Comparison of causes of liver disease showed no significant differences in the severity of neuropathy among the different etiologies. In conclusion, axonal sensory-motor polyneuropathy and autonomic neuropathy are commonly seen in patients with end-stage liver disease of different causes.
已有报道称周围神经病变与慢性肝病有关。然而，神经病变的确切发病率、严重程度和特征，以及神经病变与不同肝病病因之间的关系尚未明确。在本研究中，对58例晚期肝病患者进行了详细评估，以确定是否存在神经病变。71%的患者发现有周围（感觉运动）神经病变，48%的患者发现有自主神经病变。虽然大多数患者无症状，但神经学检查显示，17例患者（29%）存在疼痛、振动觉的远端感觉丧失或反射的远端丧失。在神经传导研究中，感觉神经病变比运动轴索性多发性神经病变更常见。定量感觉测试经常异常（62%），冷却阈值比振动阈值受影响更大。总体而言，肝病患者的神经病变模式符合“逆行性”或长度依赖性神经病变的预期模式。在晚期肝失代偿患者中，神经病变最为严重。对肝病病因的比较显示，不同病因之间神经病变的严重程度无显著差异。总之，轴索性感觉运动性多发性神经病变和自主神经病变在不同病因的终末期肝病患者中很常见。
