Kalaitzakis Evangelos, Josefsson Axel, Castedal Maria, Henfridsson Pia, Bengtsson Maria, Andersson Bengt, Björnsson Einar
Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Scand J Gastroenterol. 2013 May;48(5):577-84. doi: 10.3109/00365521.2013.777468. Epub 2013 Mar 4.
Although muscle wasting may lead to decreased ammonia detoxification in cirrhosis, the potential role of lean mass depletion in hepatic encephalopathy (HE) has not been explored. Anemia, hormonal abnormalities, and psychological distress may contribute to cognitive dysfunction, but data on their potential relation to HE are limited.
Data on 108 cirrhotic liver transplant candidates enrolled in a prospective study on fatigue were retrospectively analyzed. HE was assessed clinically and with the number connection tests (NCT) A and B. Psychosocial distress was assessed with a validated questionnaire. Fasting serum glucose, insulin, ammonia, and the glomerular filtration rate (GFR) were measured. Fat and fat-free mass was evaluated with dual-energy X-ray absorptiometry. Serum cortisol, testosterone, dehydroepiandrosterone, thyroid function tests, interleukin-6, and tumor necrosis factor-α (TNF-α) were measured in a subgroup of 80 patients.
A total of 28% of patients had (overt or minimal) HE. Anemia was present in 59%, diabetes in 29%, renal impairment in 16%, and fat-free mass depletion in 14%. In multivariate analysis, fat-free mass depletion was an independent predictor of HE and NCT-A; renal impairment of NCT-A and -B; and anemia of NCT-B (p < 0.05 for all). HE was also independently related to international normalized ratio and TNF-α (p < 0.05 for both), but not to other hormonal abnormalities or psychological distress. Plasma ammonia was independently associated to anemia (beta = 15.24, p = 0.049), fasting insulin (beta = 0.26, p < 0.05), and GFR (beta = -0.43, p = 0.003).
Anemia and fat-free mass depletion are predictors of HE in cirrhotic liver transplant candidates along with liver failure, renal impairment, and systemic inflammation.
尽管肌肉消耗可能导致肝硬化患者氨解毒能力下降，但瘦体重减少在肝性脑病（HE）中的潜在作用尚未得到探索。贫血、激素异常和心理困扰可能导致认知功能障碍，但它们与HE潜在关系的数据有限。
对纳入一项关于疲劳的前瞻性研究的108例肝硬化肝移植候选者的数据进行回顾性分析。通过临床评估以及数字连接试验（NCT）A和B评估HE。使用经过验证的问卷评估心理社会困扰。测量空腹血清葡萄糖、胰岛素、氨和肾小球滤过率（GFR）。采用双能X线吸收法评估脂肪和去脂体重。在80例患者的亚组中测量血清皮质醇、睾酮、脱氢表雄酮、甲状腺功能测试、白细胞介素-6和肿瘤坏死因子-α（TNF-α）。
共有28%的患者患有（显性或轻微）HE。59%的患者存在贫血，29%的患者患有糖尿病，16%的患者存在肾功能损害，14%的患者存在去脂体重减少。在多变量分析中，去脂体重减少是HE和NCT-A的独立预测因素；肾功能损害是NCT-A和NCT-B的独立预测因素；贫血是NCT-B的独立预测因素（所有p<0.05）。HE还与国际标准化比值和TNF-α独立相关（两者p<0.05），但与其他激素异常或心理困扰无关。血浆氨与贫血（β=15.24，p=0.049）、空腹胰岛素（β=0.26，p<0.05）和GFR（β=-0.43，p=0.003）独立相关。
贫血和去脂体重减少是肝硬化肝移植候选者发生HE的预测因素，同时还有肝功能衰竭、肾功能损害和全身炎症。
