2月份,Clin Gastroenterol Hepatol杂志上报告的一项研究"Factors Related to Fatigue in Patients With Cirrhosis Before and After Liver Transplantation"显示,肝硬化患者较匹配的一般人群对照更易疲乏,接受肝移植1年后这种疲乏仍有可能存在,并且与抑郁、焦虑以及生活质量受损高度相关。
在此研究中,瑞典哥德堡大学的Evangelos Kalaitzakis博士及其同事对2004年5月~2007年4月就诊的108例肝硬化患者进行了研究。患者平均年龄为52岁,其中36例为女性。入选研究时,所有患者完成了疲乏影响问卷(FIS),评估了身体、社会心理和认知领域的疲乏表现,并得出一个总体疲乏评分。将患者与一个瑞典一般人群的随机样本进行比较,并与肝硬化患者进行匹配。将FIS评分较一般人群队列高出2个标准差定义为疲乏。
结果显示,基线时,肝硬化患者的总体FIS评分显著高于对照组,身体、社会心理和认知领域的疲劳评分均显著增高(P 值均<0 .001)。研究参与者同时完成了医院焦虑和抑郁量表(HAD)的评估。并且,HAD评估的抑郁和焦虑评分均与FIS评估的总体疲乏评分高度相关(P<0.001)。研究中还发现,与对照组相比,肝硬化患者发生临界或有意义的焦虑(分别为12% vs. 21%,8% vs. 16%,P=0.034)以及临界或有意义的抑郁(分别为9% vs. 23%,6% vs. 14%,P=0.001)的风险增高。
根据分析,临床因素也起到一定作用。单变量分析发现Child-Pugh分级较高、当前有腹水表现或腹水病史均与总体疲乏显著相关(P 值均<0.001)。当前有显性肝性脑病也与总体疲乏显著相关,但相关性低于其他因素(P<0.05)。与总体疲乏无显著相关性的因素包括肝病病因、有无稳定或出血性静脉曲张和营养不良。实际上,在多变量分析中,FIS评分仅与抑郁、焦虑、Child-Pugh评分和低血清可的松水平相关。
108例患者中共有66例接受肝脏移植,其中60例患者可获取1年时随访数据。“移植后1年时,FIS各领域和总体评分均有改善,但移植受者的身体疲乏评分仍高于对照组”。在移植之前根据FIS评分评定为身体疲乏的37例患者中,17例(46%)在移植之后仍被评定为疲乏。与移植后疲乏程度降低的患者相比,这17例仍被评定为疲乏的患者中,基线时HAD评定为有意义或临界抑郁的比例更高(分别为15% vs. 35%,15% vs. 41%;P=0.019)。
研究者认为,心理困扰是肝硬化患者疲劳的一个主要决定因素。Kalaitzakis博士及其合作者披露无相关利益冲突,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.