2月份,，Clin Gastroenterol Hepatol雜志上報告的一項研究"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,。
在此研究中,，瑞典哥德堡大學的Evangelos Kalaitzakis博士及其同事對2004年5月~2007年4月就診的108例肝硬化患者進行了研究?；颊咂骄挲g為52歲,，其中36例為女性。入選研究時,，所有患者完成了疲乏影響問卷(FIS),，評估了身體、社會心理和認知領域的疲乏表現(xiàn),，并得出一個總體疲乏評分,。將患者與一個瑞典一般人群的隨機樣本進行比較,，并與肝硬化患者進行匹配。將FIS評分較一般人群隊列高出2個標準差定義為疲乏,。
結(jié)果顯示,，基線時，肝硬化患者的總體FIS評分顯著高于對照組,，身體,、社會心理和認知領域的疲勞評分均顯著增高(P 值均<0 .001)。研究參與者同時完成了醫(yī)院焦慮和抑郁量表(HAD)的評估,。并且,，HAD評估的抑郁和焦慮評分均與FIS評估的總體疲乏評分高度相關(P<0.001)。研究中還發(fā)現(xiàn),，與對照組相比,，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)的風險增高,。
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分級較高,、當前有腹水表現(xiàn)或腹水病史均與總體疲乏顯著相關(P 值均<0.001),。當前有顯性肝性腦病也與總體疲乏顯著相關，但相關性低于其他因素(P<0.05),。與總體疲乏無顯著相關性的因素包括肝病病因,、有無穩(wěn)定或出血性靜脈曲張和營養(yǎng)不良。實際上,，在多變量分析中,，F(xiàn)IS評分僅與抑郁、焦慮,、Child-Pugh評分和低血清可的松水平相關,。
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年時隨訪數(shù)據(jù),。“移植后1年時,，F(xiàn)IS各領域和總體評分均有改善，但移植受者的身體疲乏評分仍高于對照組”,。在移植之前根據(jù)FIS評分評定為身體疲乏的37例患者中,，17例(46%)在移植之后仍被評定為疲乏。與移植后疲乏程度降低的患者相比，這17例仍被評定為疲乏的患者中,，基線時HAD評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),。
研究者認為,，心理困擾是肝硬化患者疲勞的一個主要決定因素。Kalaitzakis博士及其合作者披露無相關利益沖突,，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.
