Kalaitzakis Evangelos, Björnsson Einar
Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Scand J Gastroenterol. 2007 Oct;42(10):1238-44. doi: 10.1080/00365520701373983.
Cognitive impairment is a common problem in patients with liver cirrhosis. Its pathogenesis is multifactorial and ammonia is considered to play a central role. Renal function has been shown to be important for ammonia metabolism in cirrhosis. Although renal dysfunction is common in cirrhotic patients, its effect on cognitive function is largely unexplored.
A total of 128 consecutive cirrhotic patients were prospectively evaluated for the presence of cognitive dysfunction according to the West-Haven criteria and by means of two psychometric tests. Serum creatinine, sodium and potassium as well as plasma ammonia concentrations were assessed. Glomerular filtration rate was also measured by (51)Cr- EDTA clearance in a subgroup of patients.
Forty-one patients (32%) were found to have cognitive dysfunction (clinical evaluation and/or psychometric tests). Sixteen patients (13%) found with serum creatinine levels above reference values had cognitive dysfunction more frequently than patients with creatinine within the normal range (69% versus 31%; p = 0.001), but did not differ in aetiology or severity of cirrhosis (p >0.1). Patients with loop diuretics versus without did not differ in creatinine values (p >0.1). Multivariate analysis showed that cognitive dysfunction was related to hospital admission at inclusion in the study, international normalized ratio and serum creatinine (p <0.05 for all), but not to potassium or sodium levels. Plasma ammonia concentration was related to serum creatinine (r = 0.26, p = 0.004) and the glomerular filtration rate (r = -0.44, p = 0.023).
Renal dysfunction seems to be related to cognitive impairment in patients with liver cirrhosis and might be implicated in the pathogenesis of hepatic encephalopathy.
认知障碍是肝硬化患者的常见问题。其发病机制是多因素的，氨被认为起核心作用。肾功能已被证明对肝硬化患者的氨代谢很重要。虽然肾功能不全在肝硬化患者中很常见，但其对认知功能的影响在很大程度上尚未得到探索。
根据西黑文标准并通过两项心理测量测试，对128例连续的肝硬化患者进行前瞻性评估，以确定是否存在认知功能障碍。评估血清肌酐、钠和钾以及血浆氨浓度。还通过（51）铬-乙二胺四乙酸清除率测量了部分患者的肾小球滤过率。
41例患者（32%）被发现存在认知功能障碍（临床评估和/或心理测量测试）。16例血清肌酐水平高于参考值的患者比肌酐在正常范围内的患者更频繁地出现认知功能障碍（69%对31%；p = 0.001），但在肝硬化的病因或严重程度方面没有差异（p > 0.1）。使用袢利尿剂的患者与未使用的患者在肌酐值方面没有差异（p > 0.1）。多变量分析表明，认知功能障碍与纳入研究时的住院情况、国际标准化比值和血清肌酐有关（所有p < 0.05），但与钾或钠水平无关。血浆氨浓度与血清肌酐（r = 0.26，p = 0.004）和肾小球滤过率（r = -0.44，p = 0.023）有关。
肾功能不全似乎与肝硬化患者的认知障碍有关，可能参与了肝性脑病的发病机制。
