Warner Edgewood R, Aloor Fuad Z, Satapathy Sanjaya K
Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, Manhasset, NY, USA.
Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases and Transplantation, Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, Manhasset, New York, USA.
Transl Gastroenterol Hepatol. 2022 Jan 25;7:5. doi: 10.21037/tgh-20-325. eCollection 2022.
The purpose of this manuscript is to identify the pathophysiology of the metabolic abnormalities observed in cirrhosis and to uncover associations, if any, to its complications, such as sarcopenia and hepatic encephalopathy (HE).
Liver dysfunction in cirrhosis is known to be a precipitating factor in the disruption of many physiological pathways, specifically nutrient metabolism. As a result, affected patients are highly susceptible to derangements of processes affecting multiple classes of macro- and micronutrients, including proteins, carbohydrates, electrolytes, vitamins, and minerals. These disruptions are thought to be contributory to the pathogenesis of known complications of cirrhosis.
Literature research of relevant topics was conducted for the above stated objective; sources were limited to articles from peer-reviewed journals published within the last 30 years.
This research established that there is positive correlation between nutrient derangements and the increased risk of complications of cirrhosis, which themselves carry significant morbidity and mortality risk. It also established that some nutrient and electrolyte abnormalities are independent indicators of prognosis and adverse outcomes, such as mortality. This also highlights the importance of comprehension of anomalous metabolism and its complications as it necessitates serious consideration in clinical care. In addition to medical management, cirrhotic patients also require ancillary assessment, such as comprehensive nutritional evaluation, to identify and treat reversible nutritional derangements. This consideration provides the best opportunity to achieve maximal health outcomes in the cirrhotic patient population.
本手稿旨在确定肝硬化中观察到的代谢异常的病理生理学，并揭示其与诸如肌肉减少症和肝性脑病（HE）等并发症之间的关联（若存在）。
肝硬化中的肝功能障碍是许多生理途径（特别是营养代谢）紊乱的诱发因素。因此，受影响的患者极易出现影响多种常量和微量营养素（包括蛋白质、碳水化合物、电解质、维生素和矿物质）的过程紊乱。这些紊乱被认为是肝硬化已知并发症发病机制的促成因素。
为实现上述目标，对相关主题进行了文献研究；资料限于过去30年内发表的同行评审期刊文章。
本研究证实营养紊乱与肝硬化并发症风险增加之间存在正相关，而这些并发症本身具有显著的发病和死亡风险。研究还证实，一些营养和电解质异常是预后及不良结局（如死亡率）的独立指标。这也凸显了理解异常代谢及其并发症的重要性，因为在临床护理中需要认真考虑。除了药物治疗外，肝硬化患者还需要进行辅助评估，如全面的营养评估，以识别和治疗可逆的营养紊乱。这种考虑为在肝硬化患者群体中实现最佳健康结局提供了最佳机会。
