Verne G Nicholas, Soldevia-Pico Consuelo, Robinson Michael E, Spicer Kenneth M, Reuben Adrian
Divisions of Gastroenterology, Hepatology, and Nutrition, University of Florida, Malcom Randall VAMC, 1601 SW Archer Road, Gainesville, FL 32608, USA.
J Clin Gastroenterol. 2004 Jan;38(1):72-6. doi: 10.1097/00004836-200401000-00015.
Patients with cirrhosis of the liver frequently present with many gastrointestinal complaints that are most likely due to abnormal gastrointestinal motility. The cause of these motility disorders in cirrhotics is unknown, however, underlying autonomic dysfunction may play a role.
To determine the association between autonomic dysfunction and delayed gastric emptying in cirrhotic patients.
We prospectively studied 20 patients with cirrhosis of the liver and postprandial abdominal pain, nausea, and vomiting and 10 asymptomatic patients with Hepatitis C (HCV) and no evidence of cirrhosis. All patients underwent 5 standardized cardiovascular tests to assess autonomic function. Each test was scored on a continuum from 0 (normal) to 5 (severe disease), thus producing a composite score of 0 to 5 for each subject. A composite score of greater than 1.5 was considered abnormal, with 5 representing severe autonomic involvement. A solid phase gastric emptying study was performed in each patient and a gastric retention of greater than 50% at 100 minutes was considered abnormal.
The mean percent retention at 100 minutes was 70.7% in the cirrhotic group vs. 26.1% (P < 0.001) in the patients with HCV and no evidence of cirrhosis (controls). The composite autonomic score for the cirrhotic group was 3.4 vs. 1.2 (P < 0.001) in the controls.
Our results suggest that gastroparesis is common in patients with cirrhosis of the liver, and may account for gastrointestinal symptoms of postprandial abdominal pain, nausea, and vomiting. The presence of autonomic dysfunction correlates positively with underlying motility disorders, such as delayed gastric emptying.
肝硬化患者常出现多种胃肠道不适症状，很可能是由于胃肠动力异常所致。然而，这些肝硬化患者胃肠动力障碍的病因尚不清楚，自主神经功能障碍可能在其中发挥作用。
确定肝硬化患者自主神经功能障碍与胃排空延迟之间的关联。
我们前瞻性地研究了20例患有肝硬化且有餐后腹痛、恶心和呕吐症状的患者以及10例无症状丙型肝炎（HCV）且无肝硬化证据的患者。所有患者均接受5项标准化心血管测试以评估自主神经功能。每项测试的评分范围为0（正常）至5（严重疾病），因此每个受试者的综合评分为0至5。综合评分大于1.5被认为异常，5表示严重自主神经受累。对每位患者进行了固相胃排空研究，100分钟时胃潴留大于50%被认为异常。
肝硬化组100分钟时的平均潴留百分比为70.7%，而无肝硬化证据的HCV患者（对照组）为2.61%（P<0.001）。肝硬化组的自主神经综合评分为3.4，而对照组为1.2（P<0.001）。
我们的结果表明，胃轻瘫在肝硬化患者中很常见，可能是餐后腹痛、恶心和呕吐等胃肠道症状的原因。自主神经功能障碍的存在与潜在的动力障碍呈正相关，如胃排空延迟。
