Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy.
Liver Int. 2010 Feb;30(2):232-9. doi: 10.1111/j.1478-3231.2009.02125.x. Epub 2009 Sep 28.
Autonomic dysfunction has been reported as one of the complications of cirrhosis.
The aim of this study was to test autonomic dysfunction in cirrhotic patients by analysing the baroreflex sensitivity and the baroreceptor effectiveness index (BEI), in order to determine its correlation with the severity and the aetiology of liver disease. Moreover, we explored the relationship between baroreceptor function and mortality in our cohort of patients.
Clinical and laboratory evaluation, hepatic venous pressure gradient (HVPG) and haemodynamic setting and baroreceptor function were assessed in 45 cirrhotic patients (median age 55, range 38-72 years) divided in groups according to the severity of their disease (26 patients Child A, 13 patients Child B and six patients Child C).
Baroreceptor sensitivity and BEI were impaired in more advanced cirrhotic patients compared with subjects with milder disease (P<0.001). HVPG was significantly, independently and inversely correlated with baroreceptor sensitivity (P=0.003). More severe impairment of baroreceptor function was associated with a higher mortality (P=0.04) and subjects with alcohol-related cirrhosis presented worse baroreceptor function (P=0.032) and poorer survival (P=0.003) compared with subjects with post-viral liver disease.
These data support the hypothesis that liver disease severity and particularly portal hypertension have an important role in the derangement of baroreceptor function. The aetiology of cirrhosis seems to be related to baroreceptor impairment as well. Mortality rate is higher in subjects with a more damaged autonomic system, strengthening the idea of a worse prognosis in cirrhotic patients with autonomic neuropathy.
自主神经功能障碍已被报道为肝硬化的并发症之一。
本研究旨在通过分析压力感受性反射敏感性和压力感受性反射效能指数（BEI）来检测肝硬化患者的自主神经功能障碍，以确定其与肝病的严重程度和病因的相关性。此外，我们还探讨了我们的患者队列中压力感受器功能与死亡率之间的关系。
对 45 例肝硬化患者（中位年龄 55 岁，范围 38-72 岁）进行临床和实验室评估、肝静脉压力梯度（HVPG）和血流动力学设置以及压力感受器功能评估，并根据疾病严重程度将患者分为三组（26 例 Child A 级、13 例 Child B 级和 6 例 Child C 级）。
与病情较轻的患者相比，病情较重的肝硬化患者的压力感受器敏感性和 BEI 受损更为明显（P<0.001）。HVPG 与压力感受器敏感性呈显著、独立和负相关（P=0.003）。压力感受器功能的严重受损与更高的死亡率相关（P=0.04），且酒精性肝硬化患者的压力感受器功能较差（P=0.032），生存率较低（P=0.003）。
这些数据支持这样一种假设，即肝病的严重程度，特别是门静脉高压，在压力感受器功能障碍中起着重要作用。肝硬化的病因似乎也与压力感受器的损害有关。死亡率在自主神经系统受损更严重的患者中更高，这进一步证实了在自主神经病变的肝硬化患者中预后更差的观点。
