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 Nov;48(11):1308-16. doi: 10.3109/00365521.2013.836755. Epub 2013 Sep 25.
Gastrointestinal (GI) symptoms are common in cirrhosis and have an impact on quality of life. Their pathophysiology and their relation to energy intake have not been fully elucidated and the effect of liver transplantation on GI symptoms has not been studied. We aimed to prospectively evaluate GI symptoms and their determinants before and after transplantation and their potential relation with energy intake in cirrhosis.
A total of 108 cirrhotic liver transplant candidates completed the Gastrointestinal Symptom Rating Scale (GSRS) and the hospital anxiety and depression scale. Fasting serum glucose and insulin were measured in all patients. Serum thyrotropin, free T3/T4, cortisol, free testosterone, estradiol, dehydroepiandrosterone sulfate, interleukin-6 and tumor necrosis factor-α were measured in a subgroup of 80 patients. Transplant recipients were followed for 1 year. A separate cohort of 40 cirrhotic patients underwent a high-caloric satiation drinking test (SDT).
GI symptoms were more severe in cirrhotics compared to controls from the general population. In regression analysis, the total GSRS score was independently related to lactulose, anxiety and low free testosterone (p < 0.05 for all). Four out of six GSRS domain scores improved significantly 1 year post-transplant (p < 0.05) but the total GSRS score remained higher compared to controls. GI symptoms predicted ingestion of fewer calories at SDT compared to other patients and controls (p < 0.05).
Psychological distress, lactulose treatment and low testosterone are predictors of GI symptoms which are common among cirrhotic transplant candidates. They are also associated with decreased energy intake as measured by a SDT. GI symptoms remain of concern post-transplant.
胃肠道（GI）症状在肝硬化患者中很常见，会影响生活质量。其病理生理学以及与能量摄入的关系尚未完全阐明，肝移植对胃肠道症状的影响也未得到研究。我们旨在前瞻性评估肝硬化患者移植前后的胃肠道症状及其决定因素，以及它们与能量摄入的潜在关系。
共有108例肝硬化肝移植候选者完成了胃肠道症状评分量表（GSRS）和医院焦虑抑郁量表。所有患者均测量空腹血糖和胰岛素。在80例患者的亚组中测量血清促甲状腺激素、游离T3/T4、皮质醇、游离睾酮、雌二醇、硫酸脱氢表雄酮、白细胞介素-6和肿瘤坏死因子-α。对移植受者进行了1年的随访。另外40例肝硬化患者组成的队列接受了高热量饱腹感饮水试验（SDT）。
与普通人群中的对照组相比，肝硬化患者的胃肠道症状更严重。回归分析显示，GSRS总分与乳果糖、焦虑和低游离睾酮独立相关（均p<0.05）。移植后1年，GSRS六个领域评分中的四个显著改善（p<0.05），但GSRS总分仍高于对照组。与其他患者和对照组相比，胃肠道症状预测SDT时热量摄入较少（p<0.05）。
心理困扰、乳果糖治疗和低睾酮是肝硬化移植候选者中常见的胃肠道症状的预测因素。通过SDT测量，它们还与能量摄入减少有关。移植后胃肠道症状仍然值得关注。
