Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia.
Clin Gastroenterol Hepatol. 2013 Nov;11(11):1511-6. doi: 10.1016/j.cgh.2013.05.010. Epub 2013 May 22.
BACKGROUND & AIMS: In patients with cirrhosis, cognitive dysfunction most often results from covert hepatic encephalopathy (HE). These patients are not tested routinely for cognitive dysfunction despite single-center evidence that it could be associated with poor socioeconomic status (SES). We investigated the association between SES and cognition in a multicenter study of cirrhosis.
In a cross-sectional study, 236 cirrhotic patients from 3 centers (84 subjects from Virginia, 102 from Ohio, and 50 from Rome, Italy; age 57.7 ± 8.6 y; 14% with prior overt HE) were given recommended cognitive tests and a validated SES questionnaire that included questions about employment, personal and family income, and overall financial security. Comparisons were made among centers and between subjects who were employed or not. Regression analysis was performed using employment and personal income as outcomes.
Only 37% of subjects had been employed in the past year. Subjects had substantial financial insecurity-their yearly personal income ranged from $16,000 to $24,999, and their family income ranged from $25,000 to $49,999. They would be able to maintain a residence for only 3 to 6 months if their income stopped, and their current liquid assets were $500 to $4999 (<$500 if debt was subtracted). Cognition and SES were worst in Ohio and best in Virginia. Cognition correlated with personal and family income, within and between centers. On regression analysis, cognitive performance (digit symbol, lures, and line tracing) was associated with personal yearly income, after controlling for demographics, country, employment, and overt HE. Unemployed subjects had a higher rate of overt HE, worse cognition, and lower personal income than employed subjects. On regression analysis, performance on digit symbol, line tracing, inhibitory control test lures, and serial dotting tests remained associated with employment, similar to income.
In an international multicenter study of patients with cirrhosis, socioeconomic condition, based on employment and personal income, was associated strongly with cognitive performance, independent of age, education, and country.
在肝硬化患者中，认知功能障碍通常是由隐匿性肝性脑病（HE）引起的。尽管有单中心证据表明，认知功能障碍可能与较差的社会经济地位（SES）有关，但这些患者并未常规进行认知功能障碍测试。我们在一项肝硬化多中心研究中调查了 SES 与认知功能之间的关系。
在一项横断面研究中，我们对来自 3 个中心的 236 名肝硬化患者（弗吉尼亚州 84 例，俄亥俄州 102 例，意大利罗马 50 例；年龄 57.7±8.6 岁；14%的患者既往有显性 HE）进行了推荐的认知测试和经过验证的 SES 问卷，该问卷包括关于就业、个人和家庭收入以及整体财务安全的问题。我们比较了中心之间以及有或没有工作的患者之间的差异。使用就业和个人收入作为结果进行回归分析。
只有 37%的患者在过去一年中就业过。患者的财务状况非常不稳定——他们的年收入在 16000 美元至 24999 美元之间，家庭收入在 25000 美元至 49999 美元之间。如果他们的收入停止，他们只能维持 3 到 6 个月的住所，而他们目前的流动资产为 500 美元至 4999 美元（减去债务后，如果债务低于 500 美元）。认知功能和 SES 在俄亥俄州最差，在弗吉尼亚州最好。认知功能与个人和家庭收入在中心内和中心之间相关。在回归分析中，控制了人口统计学、国家、就业和显性 HE 后，认知表现（数字符号、诱饵和线追踪）与个人年收入相关。与就业者相比，失业者显性 HE 发生率更高、认知功能更差、个人收入更低。在回归分析中，数字符号、线追踪、抑制控制测试诱饵和连续打点测试的表现仍然与就业相关，与收入相似。
在一项肝硬化患者的国际多中心研究中，基于就业和个人收入的社会经济状况与认知表现密切相关，独立于年龄、教育和国家。
