Cavaggioni Gabriele, Poli Edoardo, Ferri Flaminia, Parlati Lucia, Monaco Valentina, Melcore Claudia, Lattanzi Barbara, Merli Manuela, Mennini Gianluca, Melandro Fabio, Rossi Massimo, Ginanni Corradini Stefano
Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy.
Department of Clinical Medicine, Division of Gastroenterology, "Sapienza" University of Rome, Viale dell' Università 37, 00185, Rome, Italy.
Metab Brain Dis. 2017 Jun;32(3):923-933. doi: 10.1007/s11011-017-9987-2. Epub 2017 Apr 11.
Psychopathological symptoms and reduced health related quality of life (HRQoL) are frequent in cirrhotics, but no data on their association with cirrhosis prognosis assessed by the MELDNa score are available. Prospective data on the long-term effect of deceased donor liver transplantation (LT) on psychopathological symptoms are needed. Before entering the LT waiting list, 44 consecutive LT cirrhotic candidates without a major psychiatric disorder underwent a psychopathological assessment, including Symptom Checklist-90-revised (SCL-90-R) and Defense Style Questionnaire (DSQ). HRQoL was measured by Short Form 36 Health Survey (SF-36). Abnormal performance at each questionnaire was defined by using 44 age, gender, BMI and education-matched healthy subjects. Separate binary logistic regression models were used to test the association of the Child-Pugh, MELD and MELDNa scores with abnormal performance at each questionnaire. Fourteen patients repeated the battery tests 3 years after LT. Before LT, increasing MELDNa was the only prognostic score independently associated with an abnormal SCL-90-R global psychopathological score index (OR: 1.207; 95% CI: 1.026-1.420; P = 0.02) and the best independent predictor of reduced HRQoL. After LT, compared to status prior to LT, performance at SF-36 general health perception scale ameliorated (P = 0.02), performance at SCL-90-R somatization scale (P = 0.001) and global psychopathological score index (P < 0.001) worsened and the negative correlation between the psychopathological global score index and HRQoL disappeared. The severity of cirrhosis in LT candidates should be monitored by the MELDNa score to better establish the right psychological counselling. Psychopathology, and in particular somatization, worsens after LT and should be carefully investigated.
心理病理症状和健康相关生活质量（HRQoL）下降在肝硬化患者中很常见，但尚无关于它们与MELDNa评分评估的肝硬化预后之间关联的数据。需要有关已故供体肝移植（LT）对心理病理症状长期影响的前瞻性数据。在进入LT等待名单之前，44名连续的无重大精神疾病的LT肝硬化候选者接受了心理病理评估，包括症状自评量表-90修订版（SCL-90-R）和防御方式问卷（DSQ）。HRQoL通过简短健康调查量表（SF-36）进行测量。使用44名年龄、性别、BMI和教育程度匹配的健康受试者来定义每份问卷的异常表现。采用单独的二元逻辑回归模型来测试Child-Pugh、MELD和MELDNa评分与每份问卷异常表现之间的关联。14名患者在LT后3年重复进行了全套测试。LT前，MELDNa升高是唯一与SCL-90-R总体心理病理评分指数异常独立相关的预后评分（OR：1.207；95%CI：1.026-1.420；P = 0.02），也是HRQoL降低的最佳独立预测因素。LT后，与LT前状态相比，SF-36总体健康感知量表的表现有所改善（P = 0.02），SCL-90-R躯体化量表（P = 0.001）和总体心理病理评分指数（P < 0.001）的表现恶化，且心理病理总体评分指数与HRQoL之间的负相关消失。LT候选者的肝硬化严重程度应由MELDNa评分进行监测，以便更好地确定合适的心理咨询。心理病理学，尤其是躯体化，在LT后会恶化，应仔细调查。
