Kośnik Artur, Wójcicki Maciej
Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland.
Doctoral School of Medical University of Warsaw, Warsaw, Poland.
Prz Gastroenterol. 2022;17(1):21-27. doi: 10.5114/pg.2022.114594. Epub 2022 Mar 18.
Fatigue is the most commonly encountered symptom in patients with chronic liver disease (CLD). The resulting decrease in quality of life contributes markedly to the societal costs of fatigue. Moreover, fatigue is associated with social dysfunction, increased daytime somnolence, impaired working ability, and increased risk of mortality. Fatigue is not related to the severity of the underlying liver fibrosis or dysfunction. In CLD patients, fatigue manifests with both central symptoms, characterised by cognitive impairment, sleep disturbance, apathy, and autonomic dysfunction, and peripheral symptoms, characterised by decreased exercise tolerance and reduced physical activity levels. The pathogenesis of fatigue in CLD is multifactorial and involves changes in the brain-liver axis resulting from changes in inflammatory cytokines or the gut microbiome. Numerous interventions have attempted to alleviate fatigue in CLD by improving its central and peripheral manifestations or the underlying liver disease. Currently, however, there are no widely accepted or effective treatments for fatigue in CLD patients. In this review, we highlight the problem of fatigue in CLD, the current theories regarding its pathogenesis, and current approaches to its treatment.
疲劳是慢性肝病（CLD）患者最常出现的症状。由此导致的生活质量下降显著增加了疲劳的社会成本。此外，疲劳与社会功能障碍、白天嗜睡增加、工作能力受损以及死亡风险增加有关。疲劳与潜在肝纤维化或功能障碍的严重程度无关。在CLD患者中，疲劳表现为中枢症状，其特征为认知障碍、睡眠障碍、冷漠和自主神经功能障碍，以及外周症状，其特征为运动耐力下降和身体活动水平降低。CLD中疲劳的发病机制是多因素的，涉及炎症细胞因子或肠道微生物群变化导致的脑-肝轴改变。许多干预措施试图通过改善其中心和外周表现或潜在的肝脏疾病来减轻CLD中的疲劳。然而，目前尚无被广泛接受或有效的CLD患者疲劳治疗方法。在本综述中，我们强调了CLD中疲劳的问题、当前关于其发病机制的理论以及当前的治疗方法。
