Arguedas Miguel R, DeLawrence Thomas G, McGuire Brendan M
Department of Medicine, Division of Gastroenterology & Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Dig Dis Sci. 2003 Aug;48(8):1622-6. doi: 10.1023/a:1024784327783.
Cirrhosis is associated with decrements in health-related quality of life (HRQOL), but the specific effects of encephalopathy, especially subclinical, on quality of life are incompletely understood. Therefore, the aim of our study was to define the effects of encephalopathy on specific domains of HRQOL in a sample of patients with advanced liver disease. The sample consisted of 160 patients with cirrhosis presenting for liver transplantation evaluation. Health-related quality of life was measured with the Short Form-36 questionnaire. Clinical, demographic, and laboratory data were collected. The presence and degree of encephalopathy was ascertained clinically and by the use of the Reitan trail test. HRQOL scores were compared according to liver disease severity and to the presence and degree of encephalopathy. In addition, scores were compared to US population norms. Data were obtained from 148 patients. Compared to the US general population, the physical and mental component summary scores were lower in patients with cirrhosis. Among patients with cirrhosis, there were no significant differences in the physical and mental component summary scores according to age, gender, ethnicity, and etiology (hepatocellular versus/cholestatic and HCV versus non-HCV). Increasing severity of liver disease (based on the Child-Pugh score), a history of hospitalizations, and a history of ascites were associated with decreased physical component summary scores but not mental component summary scores. Patients with encephalopathy (overt and subclinical) had decreased physical and mental component summary scores compared to patients without encephalopathy. Compared to patients without encephalopathy, those with subclinical encephalopathy had a lower mental component summary score. In conclusion, cirrhosis is associated with a decreased HRQOL, especially at advanced stages. Increased severity of liver disease is associated with decreased physical aspects of quality of life. Overt hepatic encephalopathy negatively affects both physical and mental aspects of quality of life, whereas subclinical encephalopathy affects mainly the mental aspects, independently of liver disease severity.
肝硬化与健康相关生活质量（HRQOL）下降有关，但脑病，尤其是亚临床脑病对生活质量的具体影响尚未完全明确。因此，我们研究的目的是确定脑病对晚期肝病患者样本中HRQOL特定领域的影响。样本包括160名前来接受肝移植评估的肝硬化患者。使用简短健康调查问卷（Short Form-36 questionnaire）来测量健康相关生活质量。收集了临床、人口统计学和实验室数据。通过临床检查和使用雷坦试验（Reitan trail test）确定脑病的存在和程度。根据肝病严重程度以及脑病的存在和程度比较HRQOL评分。此外，还将评分与美国人群标准进行了比较。数据来自148名患者。与美国普通人群相比，肝硬化患者的身体和心理综合评分较低。在肝硬化患者中，根据年龄、性别、种族和病因（肝细胞性与胆汁淤积性以及丙型肝炎病毒感染与非丙型肝炎病毒感染），身体和心理综合评分没有显著差异。肝病严重程度增加（基于Child-Pugh评分）、有住院史和腹水史与身体综合评分降低有关，但与心理综合评分无关。与无脑病患者相比，有脑病（显性和亚临床）的患者身体和心理综合评分降低。与无脑病患者相比，有亚临床脑病的患者心理综合评分较低。总之，肝硬化与HRQOL下降有关，尤其是在晚期。肝病严重程度增加与生活质量的身体方面下降有关。显性肝性脑病对生活质量的身体和心理方面均有负面影响，而亚临床脑病主要影响心理方面，且与肝病严重程度无关。
