Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, Liaoning, P.R. China.
Postgraduate College, Jinzhou Medical University, Jinzhou, Liaoning P R. China.
Postgrad Med. 2021 Aug;133(6):626-638. doi: 10.1080/00325481.2021.1930560. Epub 2021 Jun 16.
Lipid metabolism is often disrupted in liver cirrhosis. The present study aimed to evaluate the impact of lipid profile on decompensation events, severity of liver dysfunction, and death in patients with liver cirrhosis.
In a cross-sectional study, 778 patients with lipid profile data were enrolled, and then were divided into 240 and 538 patients with and without liver cirrhosis, respectively. In a cohort study, 314 cirrhotic patients with lipid profile data, who were prospectively followed, were enrolled. Lipid profile included total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), triglycerides (TG), and lipoprotein(a).
In the cross-sectional study, cirrhotic patients with decompensation events had significantly lower levels of TC and lipoprotein(a) than those without; and cirrhotic patients with Child-Pugh class B and C had significantly lower levels of TC, HDL-c, LDL-c, and lipoprotein(a) than those with Child-Pugh class A. In the cohort study, there was an inverse association of survival with TC, HDL-c, and lipoprotein(a) levels; after adjusting for MELD score, TC (Hazard Ratio [HR] = 1.703, P = 0.034) and HDL-c (HR = 2.036, P = 0.005), but not lipoprotein(a) (HR = 1.377, P = 0.191), remained a significant predictor of death; when TC, HDL-c, lipoprotein(a), and MELD score were included in the multivariate Cox regression analysis, HDL-c (HR = 1.844, P = 0.024) was the only independent predictor of death.
Decreased levels in specific components of lipid profile indicate more decompensation events, worse liver function, and reduced survival in liver cirrhosis. MELD score combined with HDL-c should be promising for the assessment of outcomes of cirrhotic patients.
脂质代谢在肝硬化中常被打乱。本研究旨在评估脂质谱对肝硬化患者失代偿事件、肝功能严重程度和死亡的影响。
在一项横断面研究中，纳入了 778 名有脂质谱数据的患者，并将其分为 240 名和 538 名有和无肝硬化的患者。在一项队列研究中，纳入了 314 名有脂质谱数据且前瞻性随访的肝硬化患者。脂质谱包括总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、甘油三酯（TG）和脂蛋白（a）。
在横断面研究中，有失代偿事件的肝硬化患者的 TC 和脂蛋白（a）水平明显低于无失代偿事件的患者；Child-Pugh 分级为 B 和 C 的肝硬化患者的 TC、HDL-c、LDL-c 和脂蛋白（a）水平明显低于 Child-Pugh 分级为 A 的患者。在队列研究中，生存与 TC、HDL-c 和脂蛋白（a）水平呈负相关；在校正 MELD 评分后，TC（危险比[HR] = 1.703，P = 0.034）和 HDL-c（HR = 2.036，P = 0.005）仍然是死亡的显著预测因子，但脂蛋白（a）（HR = 1.377，P = 0.191）不是；当将 TC、HDL-c、脂蛋白（a）和 MELD 评分纳入多变量 Cox 回归分析时，HDL-c（HR = 1.844，P = 0.024）是死亡的唯一独立预测因子。
脂质谱特定成分的降低表明肝硬化患者失代偿事件更多、肝功能更差、生存率更低。MELD 评分联合 HDL-c 有望成为评估肝硬化患者预后的指标。
