Wunsch Ewa, Koziarska Dorota, Milkiewicz Małgorzata, Naprawa Grzegorz, Nowacki Przemysław, Hartleb Marek, Milkiewicz Piotr
aLiver Research Laboratories bDepartment of Neurology cMedical Biology Laboratory, Pomeranian Medical University dDepartment for Internal Medicine, A. Sokolowski Hospital, Szczecin eDepartment of Gastroenterology and Hepatology, Medical University of Silesia, Katowice fDepartment of General, Transplant and Liver Surgery of the Medical University of Warsaw, Warsaw, Poland.
Eur J Gastroenterol Hepatol. 2013 Dec;25(12):1402-7. doi: 10.1097/MEG.0b013e328365a447.
Liver cirrhosis is associated with latent systemic inflammatory response syndrome as evidenced by elevated levels of proinflammatory cytokines. It has been proposed that inflammatory mediators play a role in the pathogenesis of minimal and overt hepatic encephalopathy (HE); hence, they may also have an effect on health-related quality of life (HRQL). The aim of this study was to investigate the relationship between serum levels of interleukin-1β (IL-1β), IL-6, and IL-18 and the occurrence of minimal HE and HRQL.
Forty-two consecutive patients with liver cirrhosis were prospectively enrolled to the study. Minimal HE was detected by the Psychometric Hepatic Encephalopathy Score (PHES) and critical flicker frequency. HRQL was assessed with Chronic Liver Disease Questionnaire and 36-Item Short Form Health Survey (SF-36) questionnaires. The interleukins studied were determined using colorimetric sandwich enzyme-linked immunosorbent assay.
Serum levels of interleukins correlated with liver dysfunction, but did not discriminate patients with minimal HE from those with overt or absent HE. IL-1β and IL-6 showed significant correlations with PHES, but showed no relationship with critical flicker frequency. Serum IL-6 and IL-18 correlated with both physical-related general health and mental component summary evaluated by the SF-36 questionnaire.
This study shows that chronic inflammation plays a role in impaired HRQL in patients with cirrhosis irrespective of minimal HE.
肝硬化与潜在的全身炎症反应综合征相关，促炎细胞因子水平升高即为证据。有人提出炎症介质在轻微型和显性肝性脑病（HE）的发病机制中起作用；因此，它们也可能对健康相关生活质量（HRQL）产生影响。本研究的目的是探讨血清白细胞介素-1β（IL-1β）、IL-6和IL-18水平与轻微型HE的发生及HRQL之间的关系。
连续42例肝硬化患者前瞻性纳入本研究。通过心理测量肝性脑病评分（PHES）和临界闪烁频率检测轻微型HE。使用慢性肝病问卷和36项简短健康调查（SF-36）问卷评估HRQL。采用比色夹心酶联免疫吸附测定法测定所研究的白细胞介素。
血清白细胞介素水平与肝功能障碍相关，但无法区分轻微型HE患者与显性或无HE患者。IL-1β和IL-6与PHES显著相关，但与临界闪烁频率无关。血清IL-6和IL-18与SF-36问卷评估的身体相关总体健康和心理成分总分均相关。
本研究表明，无论是否存在轻微型HE，慢性炎症在肝硬化患者HRQL受损中均起作用。
