Hendrickse M T, Triger D R
Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield, UK.
Clin Auton Res. 1993 Aug;3(4):227-31. doi: 10.1007/BF01829010.
Chronic liver disease is accompanied by a number of circulatory changes including impairment of cardiovascular autonomic reflexes. This occurs irrespective of the aetiology of liver disease, increases in prevalence and severity with worsening hepatic function, and is related at least in part to an autonomic neuropathy. Parasympathetic abnormalities predominate and, although largely subclinical, they may play a role in the altered fluid homeostasis and neurohumoral disturbances associated with cirrhosis. On prospective follow up, the presence of autonomic impairment was associated with a five-fold increased mortality, largely from sepsis and variceal haemorrhage. Defective responses to such stressful events as a result of an afferent defect could possibly explain these findings. Further studies are required to evaluate the natural history of this complication, and determine if it is reversible with improvement in hepatic function or after liver transplantation.
慢性肝病伴有多种循环系统变化，包括心血管自主反射受损。无论肝病病因如何，这种情况都会发生，且随着肝功能恶化，其患病率和严重程度会增加，并且至少部分与自主神经病变有关。副交感神经异常占主导，尽管大多为亚临床症状，但它们可能在与肝硬化相关的体液平衡改变和神经体液紊乱中起作用。前瞻性随访显示，自主神经功能损害的存在与死亡率增加五倍有关，主要死于败血症和静脉曲张出血。由于传入缺陷导致对这类应激事件的反应缺陷可能可以解释这些发现。需要进一步研究来评估这种并发症的自然病程，并确定其是否会随着肝功能改善或肝移植后而逆转。
