Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Clin Gastroenterol Hepatol. 2012 Feb;10(2):174-81, 181.e1. doi: 10.1016/j.cgh.2011.07.029. Epub 2011 Aug 11.
BACKGROUND & AIMS: We performed a prospective study to evaluate fatigue and identify potential determinants among patients with cirrhosis. We also studied the effects of liver transplantation on fatigue in these patients.
A total of 108 patients with cirrhosis being evaluated before liver transplantation completed the fatigue impact scale (FIS), the hospital anxiety and depression (HAD) scale, and the short-form 36 (SF-36). Results were compared with controls from the general population. Fasting serum levels of insulin and glucose were measured in all patients. Levels of serum thyrotropin, free T(3) and T(4), cortisol, free testosterone, dehydroepiandrosterone sulfate, estradiol, interleukin-6, and tumor necrosis factor-α were measured in a subgroup of 80 patients. Transplant recipients were followed for 1 year.
Compared with controls, patients with cirrhosis had more pronounced fatigue, on the basis of higher FIS domain and total scores (P < .05), which were related to all SF-36 domains (r = -0.44 to -0.77, P < .001). All FIS scores improved significantly after liver transplantation, although physical fatigue levels remained higher than in controls (P < .05). In multivariate analysis, pretransplant FIS scores were only related to depression, anxiety, cirrhosis severity, and low serum levels of cortisol (P < .05 for all). Impaired renal function and anemia were independent predictors of physical fatigue (P < .05).
Fatigue is common among patients with cirrhosis and associated with impaired quality of life. Psychological distress, severity of cirrhosis, and low levels of cortisol determine general fatigue, whereas anemia and impaired renal function also contribute to physical fatigue. Physical fatigue remains of concern for patients who have received liver transplants for cirrhosis.
我们进行了一项前瞻性研究，以评估肝硬化患者的疲劳状况并确定其潜在决定因素。我们还研究了肝移植对这些患者疲劳的影响。
108 例肝硬化患者在肝移植前完成了疲劳影响量表（FIS）、医院焦虑抑郁量表（HAD）和健康调查简表 36 项（SF-36）的评估。结果与一般人群的对照组进行了比较。所有患者均检测空腹血清胰岛素和葡萄糖水平。80 例患者亚组检测了血清促甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺素、皮质醇、游离睾酮、硫酸脱氢表雄酮、雌二醇、白细胞介素-6 和肿瘤坏死因子-α的水平。移植受者随访 1 年。
与对照组相比，肝硬化患者的疲劳程度更严重，FIS 各域和总分更高（P <.05），与所有 SF-36 域均相关（r = -0.44 至 -0.77，P <.001）。肝移植后所有 FIS 评分均显著改善，但体力疲劳水平仍高于对照组（P <.05）。多元分析显示，移植前 FIS 评分仅与抑郁、焦虑、肝硬化严重程度和低皮质醇水平相关（均 P <.05）。肾功能不全和贫血是体力疲劳的独立预测因素（均 P <.05）。
疲劳在肝硬化患者中很常见，与生活质量受损相关。心理困扰、肝硬化严重程度和低皮质醇水平决定了总体疲劳，而贫血和肾功能不全也会导致体力疲劳。肝移植后，体力疲劳仍然是肝硬化患者关注的问题。
