终末期肝病中的衰弱:了解病理生理学、评估工具和管理策略。

Frailty in end-stage liver disease: Understanding pathophysiology, tools for assessment, and strategies for management.

机构信息

Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX 77030, United States.

Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, United States.

出版信息

World J Gastroenterol. 2023 Dec 14;29(46):6028-6048. doi: 10.3748/wjg.v29.i46.6028.

Abstract

Frailty and sarcopenia are frequently observed in patients with end-stage liver disease. Frailty is a complex condition that arises from deteriorations across various physiological systems, including the musculoskeletal, cardiovascular, and immune systems, resulting in a reduced ability of the body to withstand stressors. This condition is associated with declined resilience and increased vulnerability to negative outcomes, including disability, hospitalization, and mortality. In cirrhotic patients, frailty is influenced by multiple factors, such as hyperammonemia, hormonal imbalance, malnutrition, ascites, hepatic encephalopathy, and alcohol intake. Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients. It can aid in making critical decisions regarding patients' eligibility for critical care and transplantation. This, in turn, can guide the development of an individualized treatment plan for each patient with cirrhosis, with a focus on prioritizing exercise, proper nutrition, and appropriate treatment of hepatic complications as the primary lines of treatment. In this review, we aim to explore the topic of frailty in liver diseases, with a particular emphasis on pathophysiology, clinical assessment, and discuss strategies for preventing frailty through effective treatment of hepatic complications. Furthermore, we explore novel assessment and management strategies that have emerged in recent years, including the use of wearable technology and telemedicine.

摘要

衰弱和肌少症在终末期肝病患者中经常观察到。衰弱是一种复杂的状况,源于包括肌肉骨骼、心血管和免疫系统在内的各种生理系统的恶化,导致身体承受压力的能力降低。这种情况与弹性下降和对负面结果(包括残疾、住院和死亡)的易感性增加有关。在肝硬化患者中,衰弱受多种因素的影响,如血氨升高、激素失衡、营养不良、腹水、肝性脑病和饮酒。评估衰弱对于预测肝硬化患者的发病率和死亡率至关重要。它有助于就患者是否有资格接受重症监护和移植做出关键决策。这反过来又可以为每个肝硬化患者制定个体化的治疗计划,重点是优先考虑运动、适当的营养和适当治疗肝并发症作为主要治疗方法。在这篇综述中,我们旨在探讨肝脏疾病中的衰弱问题,特别强调其病理生理学、临床评估,并讨论通过有效治疗肝并发症预防衰弱的策略。此外,我们还探讨了近年来出现的新的评估和管理策略,包括使用可穿戴技术和远程医疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7fbb/10731159/689bf264e074/WJG-29-6028-g001.jpg

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