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慢性肝脏疾病中的相对肾上腺功能不全:其流行率及其对长期死亡率的影响。

Relative adrenal insufficiency in chronic liver disease: its prevalence and effects on long-term mortality.

机构信息

Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, South Korea.

出版信息

Aliment Pharmacol Ther. 2014 Oct;40(7):819-26. doi: 10.1111/apt.12891. Epub 2014 Jul 30.

Abstract

BACKGROUND

The relationship between relative adrenal insufficiency (RAI) and chronic liver disease is unclear.

AIM

To determine the frequency with which RAI is observed in noncritically ill patients at various stages of chronic liver disease, and the correlation between RAI and disease severity and long-term mortality.

METHODS

In total, 71 non-critically ill patients with liver cirrhosis (n = 54) and chronic hepatitis (n = 17) were evaluated prospectively. A short stimulation test (SST) with 250 μg of corticotrophin was performed to detect RAI. RAI was defined as an increase in serum cortisol of <9 μg/dL in patients with a basal total cortisol of <35 μg/dL.

RESULTS

RAI was observed in only 13 (24.1%) of 54 patients with cirrhosis. Compared to those without RAI, cirrhotic patients with RAI had significantly higher Child-Turcotte-Pugh score (10.3 ± 1.7 vs. 7.1 ± 1.8, mean ± s.d., P < 0.001) and Model for End-Stage Liver Disease score (14.5 ± 6.6 vs. 9.4 ± 3.7, P = 0.017). The cortisol response to corticotropin was negatively correlated with the severity of cirrhosis (P < 0.05). In addition, the mortality rate was higher in cirrhotic patients with RAI (69.2%) than in those without RAI (4.9%; P < 0.001) during the follow-up period of 20.1 ± 13.5 months (range, 5.8-51.1 months). The cumulative 1-year survival rates in cirrhotic patients with and without RAI were 69.2% and 95.0%, respectively (P = 0.05), while the corresponding cumulative 3-year survival rates were 0% and 95.0% (P < 0.001).

CONCLUSIONS

Relative adrenal insufficiency is more commonly observed in those with severe cirrhosis, and is clearly associated with more advanced liver disease and a shortened long-term survival. This suggests that relative adrenal insufficiency is an independent prognostic factor in non-critically ill patients with cirrhosis.

摘要

背景

相对肾上腺功能不全(RAI)与慢性肝病的关系尚不清楚。

目的

确定不同阶段慢性肝病非危重症患者中 RAI 的发生频率,以及 RAI 与疾病严重程度和长期死亡率之间的相关性。

方法

共前瞻性评估了 71 例非危重症肝硬化(n=54)和慢性肝炎(n=17)患者。采用 250μg 促皮质素短刺激试验(SST)检测 RAI。RAI 定义为基础总皮质醇<35μg/dL 的患者,血清皮质醇升高<9μg/dL。

结果

仅在 54 例肝硬化患者中观察到 13 例(24.1%)RAI。与无 RAI 的患者相比,有 RAI 的肝硬化患者的 Child-Turcotte-Pugh 评分(10.3±1.7 比 7.1±1.8,均值±标准差,P<0.001)和终末期肝病模型评分(14.5±6.6 比 9.4±3.7,P=0.017)明显更高。皮质醇对促皮质素的反应与肝硬化严重程度呈负相关(P<0.05)。此外,在 20.1±13.5 个月(5.8-51.1 个月)的随访期间,有 RAI 的肝硬化患者死亡率(69.2%)高于无 RAI 的患者(4.9%;P<0.001)。有 RAI 和无 RAI 的肝硬化患者的 1 年累积生存率分别为 69.2%和 95.0%(P=0.05),而相应的 3 年累积生存率分别为 0%和 95.0%(P<0.001)。

结论

相对肾上腺功能不全在严重肝硬化患者中更为常见,且与更严重的肝病和缩短的长期生存明显相关。这表明相对肾上腺功能不全是肝硬化非危重症患者的独立预后因素。

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