Gentile S, Marmo R, Peduto A, Montella F, Coltorti M
Istituto di Medicina Generale e Metodologia Clinica, II Università di Napoli, Italy.
Ital J Gastroenterol. 1994 Mar;26(2):53-8.
Autonomic neuropathy has been frequently observed in alcohol-addicts both with and without liver disease but few data are available on non-alcoholic cirrhotics. We studied the prevalence of this disorder in 113 cirrhotics (41 alcoholics and 72 non-alcoholics) to correlate it both with residual liver efficiency and the aetiology of liver cirrhosis. We used 5 cardio-vascular tests commonly adopted to assess the parasympathetic [Valsalva manoeuvre (VR), deep breathing (DB), lying-to-standing (LS)] and sympathetic function [sustained handgrip (SH) and orthostatic hypotension (OH)]. Results obtained indicate that: a) autonomic neuropathy was observed in 60% of the patients (71% in alcoholic and 57% in non-alcoholic cirrhosis; p < 0.01); b) the alterations of the parasympathetic function are significantly more frequent than those of the sympathetic function; c) DB and SH tests seem to be influenced by the compliance of the patient; DB was the most altered test and LS was the most specific and sensitive test; d) a simplified series of three diagnostic tests (2 parasympathetic: VR and LS, plus a sympathetic one: HO) is as accurate for the diagnosis as the combination of the 5 tests.
自主神经病变在患有和未患有肝病的酗酒者中均经常被观察到，但关于非酒精性肝硬化患者的数据却很少。我们研究了113例肝硬化患者（41例酗酒者和72例非酗酒者）中这种疾病的患病率，以将其与残余肝脏功能及肝硬化的病因相关联。我们采用了5种常用于评估副交感神经[瓦尔萨尔瓦动作（VR）、深呼吸（DB）、卧立位试验（LS）]和交感神经功能[持续握力试验（SH）和直立性低血压（OH）]的心血管测试。所得结果表明：a）60%的患者存在自主神经病变（酒精性肝硬化患者中为71%，非酒精性肝硬化患者中为57%；p<0.01）；b）副交感神经功能的改变比交感神经功能的改变明显更常见；c）DB和SH测试似乎受患者依从性的影响；DB是改变最明显的测试，而LS是最具特异性和敏感性的测试；d）一系列简化的三项诊断测试（2项副交感神经测试：VR和LS，加1项交感神经测试：HO）在诊断准确性上与5项测试的组合相当。
