Rega Dalia, Aiko Mika, Peñaranda Nicolás, Urios Amparo, Gallego Juan-José, Giménez-Garzó Carla, Casanova Franc, Fiorillo Alessandra, Cabrera-Pastor Andrea, San-Miguel Teresa, Ipiens Cristina, Escudero-García Desamparados, Tosca Joan, Montón Cristina, Ballester María-Pilar, Ballester José, Aparicio Luis, Ríos María-Pilar, Durbán Lucía, Mir Amparo, Kosenko Elena, Cases Paula, Felipo Vicente, Montoliu Carmina
INCLIVA, Health Research Institute, 46010 Valencia, Spain.
Servicio de Neurofisiología, Hospital Clínico de Valencia, 46010 Valencia, Spain.
J Clin Med. 2021 Jan 11;10(2):239. doi: 10.3390/jcm10020239.
Cirrhotic patients may experience alterations in the peripheral nervous system and in somatosensory perception. Impairment of the somatosensory system could contribute to cognitive and motor alterations characteristic of minimal hepatic encephalopathy (MHE), which affects up to 40% of cirrhotic patients. We assessed the relationship between MHE and alterations in thermal, vibration, and/or heat pain sensitivity in 58 cirrhotic patients (38 without and 20 with MHE according to Psychometric Hepatic Encephalopathy Score) and 39 controls. All participants underwent attention and coordination tests, a nerve conduction study, autonomic function testing, and evaluation of sensory thresholds (vibration, cooling, and heat pain detection) by electromyography and quantitative sensory testing. The detection thresholds for cold and heat pain on the foot were higher in patients with, than those without MHE. This hyposensitivity was correlated with attention deficits. Reaction times in the foot were longer in patients with, than without MHE. Patients with normal sural nerve amplitude showed altered thermal sensitivity and autonomic function, with stronger alterations in patients with, than in those without MHE. MHE patients show a general decrease in cognitive and sensory abilities. Small fibers of the autonomic nervous system and thermal sensitivity are altered early on in MHE, before large sensory fibers. Quantitative sensory testing could be used as a marker of MHE.
肝硬化患者可能会出现外周神经系统和躯体感觉的改变。躯体感觉系统受损可能导致轻微肝性脑病（MHE）的认知和运动改变，高达40%的肝硬化患者受其影响。我们评估了58例肝硬化患者（根据心理测量肝性脑病评分，38例无MHE，20例有MHE）和39名对照者中MHE与热、振动和/或热痛敏感性改变之间的关系。所有参与者均接受注意力和协调性测试、神经传导研究、自主神经功能测试，以及通过肌电图和定量感觉测试评估感觉阈值（振动、冷觉和热痛检测）。有MHE的患者足部冷觉和热痛的检测阈值高于无MHE的患者。这种感觉减退与注意力缺陷相关。有MHE的患者足部的反应时间比无MHE的患者更长。腓肠神经振幅正常的患者表现出热敏感性和自主神经功能改变，有MHE的患者比无MHE的患者改变更明显。MHE患者的认知和感觉能力普遍下降。自主神经系统的小纤维和热敏感性在MHE早期就发生改变，早于大感觉纤维。定量感觉测试可作为MHE的一个标志物。
