2月份,，Clin Gastroenterol Hepatol雜志上報(bào)告的一項(xiàng)研究"Factors Related to Fatigue in Patients With Cirrhosis Before and After Liver Transplantation"顯示,，肝硬化患者較匹配的一般人群對(duì)照更易疲乏，接受肝移植1年后這種疲乏仍有可能存在,，并且與抑郁,、焦慮以及生活質(zhì)量受損高度相關(guān),。
在此研究中,，瑞典哥德堡大學(xué)的Evangelos Kalaitzakis博士及其同事對(duì)2004年5月~2007年4月就診的108例肝硬化患者進(jìn)行了研究?；颊咂骄挲g為52歲,，其中36例為女性。入選研究時(shí),，所有患者完成了疲乏影響問(wèn)卷(FIS),，評(píng)估了身體,、社會(huì)心理和認(rèn)知領(lǐng)域的疲乏表現(xiàn)，并得出一個(gè)總體疲乏評(píng)分,。將患者與一個(gè)瑞典一般人群的隨機(jī)樣本進(jìn)行比較,，并與肝硬化患者進(jìn)行匹配。將FIS評(píng)分較一般人群隊(duì)列高出2個(gè)標(biāo)準(zhǔn)差定義為疲乏,。
結(jié)果顯示,，基線時(shí)，肝硬化患者的總體FIS評(píng)分顯著高于對(duì)照組,，身體,、社會(huì)心理和認(rèn)知領(lǐng)域的疲勞評(píng)分均顯著增高(P 值均<0 .001)。研究參與者同時(shí)完成了醫(yī)院焦慮和抑郁量表(HAD)的評(píng)估,。并且,，HAD評(píng)估的抑郁和焦慮評(píng)分均與FIS評(píng)估的總體疲乏評(píng)分高度相關(guān)(P<0.001)。研究中還發(fā)現(xiàn),，與對(duì)照組相比,，肝硬化患者發(fā)生臨界或有意義的焦慮(分別為12% vs. 21%，8% vs. 16%,，P=0.034)以及臨界或有意義的抑郁(分別為9% vs. 23%,，6% vs. 14%，P=0.001)的風(fēng)險(xiǎn)增高,。
根據(jù)分析,，臨床因素也起到一定作用。單變量分析發(fā)現(xiàn)Child-Pugh分級(jí)較高,、當(dāng)前有腹水表現(xiàn)或腹水病史均與總體疲乏顯著相關(guān)(P 值均<0.001),。當(dāng)前有顯性肝性腦病也與總體疲乏顯著相關(guān)，但相關(guān)性低于其他因素(P<0.05),。與總體疲乏無(wú)顯著相關(guān)性的因素包括肝病病因,、有無(wú)穩(wěn)定或出血性靜脈曲張和營(yíng)養(yǎng)不良。實(shí)際上,，在多變量分析中,，F(xiàn)IS評(píng)分僅與抑郁、焦慮,、Child-Pugh評(píng)分和低血清可的松水平相關(guān),。
108例患者中共有66例接受肝臟移植，其中60例患者可獲取1年時(shí)隨訪數(shù)據(jù),。“移植后1年時(shí),，F(xiàn)IS各領(lǐng)域和總體評(píng)分均有改善，但移植受者的身體疲乏評(píng)分仍高于對(duì)照組”。在移植之前根據(jù)FIS評(píng)分評(píng)定為身體疲乏的37例患者中,，17例(46%)在移植之后仍被評(píng)定為疲乏,。與移植后疲乏程度降低的患者相比，這17例仍被評(píng)定為疲乏的患者中,，基線時(shí)HAD評(píng)定為有意義或臨界抑郁的比例更高(分別為15% vs. 35%,，15% vs. 41%；P=0.019),。
研究者認(rèn)為,，心理困擾是肝硬化患者疲勞的一個(gè)主要決定因素。Kalaitzakis博士及其合作者披露無(wú)相關(guān)利益沖突,，研究中也未接受任何基金支持,。（生物谷Bioon.com）
doi:10.1016/j.cgh.2011.07.029
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Factors Related to Fatigue in Patients With Cirrhosis Before and After Liver Transplantation
Evangelos Kalaitzakis, Axel Josefsson, Maria Castedal, Pia Henfridsson, Maria Bengtsson, Irene Hugosson, Bengt Andersson, Einar Bj rnsson
Background & Aims
We performed a prospective study to evaluate fatigue and identify potential determinants among patients with cirrhosis. We also studied the effects of liver transplantation on fatigue in these patients.
Methods
A total of 108 patients with cirrhosis being evaluated before liver transplantation completed the fatigue impact scale (FIS), the hospital anxiety and depression (HAD) scale, and the short-form 36 (SF-36). Results were compared with controls from the general population. Fasting serum levels of insulin and glucose were measured in all patients. Levels of serum thyrotropin, free T3 and T4, cortisol, free testosterone, dehydroepiandrosterone sulfate, estradiol, interleukin-6, and tumor necrosis factor-α were measured in a subgroup of 80 patients. Transplant recipients were followed for 1 year.
Results
Compared with controls, patients with cirrhosis had more pronounced fatigue, on the basis of higher FIS domain and total scores (P < .05), which were related to all SF-36 domains (r = -0.44 to -0.77, P < .001). All FIS scores improved significantly after liver transplantation, although physical fatigue levels remained higher than in controls (P< .05). In multivariate analysis, pretransplant FIS scores were only related to depression, anxiety, cirrhosis severity, and low serum levels of cortisol (P < .05 for all). Impaired renal function and anemia were independent predictors of physical fatigue (P < .05).
Conclusions
Fatigue is common among patients with cirrhosis and associated with impaired quality of life. Psychological distress, severity of cirrhosis, and low levels of cortisol determine general fatigue, whereas anemia and impaired renal function also contribute to physical fatigue. Physical fatigue remains of concern for patients who have received liver transplants for cirrhosis.
