Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan.
Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan.
J Gastroenterol Hepatol. 2019 Feb;34(2):376-382. doi: 10.1111/jgh.14440. Epub 2018 Oct 3.
Hepatic parasympathetic nerves branch off the vagus nerve. The vagal and hepatic nervous systems are important in liver physiological processes and some diseases such as diabetes, obesity, and liver cirrhosis. We were interested in vagal nerve integrity and subsequent diseases in peptic ulcer patients. Herein, we used National Health Insurance database in Taiwan and retrospectively assessed the risk of developing liver cirrhosis in peptic ulcer patients with and without complications by surgical treatments.
A cohort of 357 423 peptic ulcer patients without Helicobacter pylori, hepatitis B/C virus infection, and alcoholism from 2001 to 2008 was established. A randomly selected cohort of 357 423 people without peptic ulcer that matched by age, gender, comorbidities, and index year was used for comparison. The risks of developing liver cirrhosis were assessed both in cohorts and in peptic ulcer patients with and without vagotomy at the end of 2011.
Peptic ulcer patients were with higher incidence of liver cirrhosis than those without peptic ulcer (2.63 vs 0.96 per 1000 person-years) and with a 2.79-fold adjusted hazard ratio (HR) (95% confidence interval = 2.66-2.93) based on the multivariable Cox proportional hazards regression analysis. Comparing with different peptic ulcer management strategies, the HR value for subsequent liver cirrhosis risk was the lowest in vagotomy group (HR = 0.46, 95% confidence interval = 0.33-0.64).
Peptic ulcer patients have an increased risk of developing liver cirrhosis. Moreover, there were association of vagotomy and decreased risk of subsequent liver cirrhosis in complicated peptic ulcer patients. However, further studies are warranted.
肝迷走神经发自于迷走神经。迷走神经和肝胆神经系统在肝脏生理过程和某些疾病（如糖尿病、肥胖症和肝硬化）中起着重要作用。我们对迷走神经完整性及其在消化性溃疡患者中的后续疾病感兴趣。在此，我们使用台湾的全民健康保险数据库，回顾性评估了 2001 年至 2008 年间无幽门螺杆菌、乙型肝炎/丙型肝炎病毒感染和酒精中毒的 357423 例消化性溃疡患者和接受手术治疗的有并发症的消化性溃疡患者发生肝硬化的风险。
建立了一个由 357423 例无幽门螺杆菌、乙型肝炎/丙型肝炎病毒感染和酒精中毒的消化性溃疡患者组成的队列，这些患者在 2001 年至 2008 年期间接受治疗。为了进行比较，我们随机选择了一个与年龄、性别、合并症和索引年份相匹配的 357423 名无消化性溃疡的对照组人群。我们在队列和 2011 年底行迷走神经切断术的消化性溃疡患者中评估了发生肝硬化的风险。
与无消化性溃疡的患者相比，消化性溃疡患者的肝硬化发生率更高（2.63 比 0.96/1000 人年），且多变量 Cox 比例风险回归分析显示调整后的危险比（HR）为 2.79（95%置信区间：2.66-2.93）。与不同的消化性溃疡治疗策略相比，迷走神经切断术组发生后续肝硬化风险的 HR 值最低（HR=0.46，95%置信区间：0.33-0.64）。
消化性溃疡患者发生肝硬化的风险增加。此外，在有并发症的消化性溃疡患者中，迷走神经切断术与后续肝硬化风险降低有关。然而，仍需要进一步的研究。
