Differential impact of hyponatremia and hepatic encephalopathy on health-related quality of life and brain metabolite abnormalities in cirrhosis
Differential impact of hyponatremia and hepatic encephalopathy on health-related quality of life and brain metabolite abnormalities in cirrhosis
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DOI：
10.1016/j.jhep.2013.04.023
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发表时间：
2013-09-01
影响因子：
25.7
通讯作者：
Bajaj, Jasmohan S.
中科院分区：
文献类型：
--
作者：
Ahluwalia, Vishwadeep;Wade, James B.;Bajaj, Jasmohan S.
背景与目标：低钠血症（HN）和肝脑病（HE）可以损害与健康相关的生活质量（HRQOL）和肝硬化的认知。我们旨在研究低钠血症对独立于He.Methods的认知，HRQOL和脑MR光谱法（MRS）的影响：四个肝硬化群（不，He/Hn，He he，He Hean，Hey，He），单独使用HN（钠<130 Meq/L），他+ hn）经过认知测试，使用疾病影响概况的HRQOL（SIP：更高的分数较差；心理心理和身体有亚评分）和脑MRS（肌醇（MI）和谷氨酸 +谷氨酰胺（GLX）），它们在各组之间进行了比较。戒断前/之后进行了HRQOL测试。分辨率：包括82个cirrhotics（30 no He/hn，25 He，17 He + Hn和10 Hn，Meld 12，63％的丙型肝炎）。与HE组相比，单独使用HN的cirhotics具有更好的认知（中位数异常测试，NO-HE/HN：3，HN：3.5，He：6.5，He + Hn：7，p = 0.008）。尽管认知更好，但HN只有HN患者的HRQOL总数较差，而心理社会的饮食率较差，而两个HN组（随着HE）的身体SIP较差（P <0.0001，所有比较）。脑MRS在HN中显示出最低的GLX，在HE组中显示出最高的GLX（P <0.02）。与NO/HN相比，这三个受影响（HE，HE + HN和HN）组的MI水平相当降低，并且与HRQOL差有关。六张他 + Hn cirhotics进行了利尿剂的戒断，改善了血清钠和总/社会心理sip分数。结论：低钠性肝硬化，没有他的HRQOL较差，尽管认知要比一致性更好。没有HE，HN的GLX水平最低，但是MI在受影响的组中相似。利尿剂退出后HRQOL改善。低钠血症与脑GLX和MI，认知和HRQOL具有复杂的非线性关系。 （c）2013年欧洲肝脏研究协会。由Elsevier B. V.保留所有权利。
Background & Aims: Hyponatremia (HN) and hepatic encephalopathy (HE) together can impair health-related quality of life (HRQOL) and cognition in cirrhosis. We aimed at studying the effect of hyponatremia on cognition, HRQOL, and brain MR spectroscopy (MRS) independent of HE.Methods: Four cirrhotic groups (no HE/HN, HE alone, HN alone (sodium < 130 mEq/L), HE + HN) underwent cognitive testing, HRQOL using Sickness Impact Profile (SIP: higher score is worse; has psychosocial and physical sub-scores) and brain MRS (myoinositol (mI) and glutamate + glutamine (Glx)), which were compared across groups. A subset underwent HRQOL testing before/after diuretic withdrawal.Results: 82 cirrhotics (30 no HE/HN, 25 HE, 17 HE + HN, and 10 HN, MELD 12, 63% hepatitis C) were included. Cirrhotics with HN alone and without HE/HN had better cognition compared to HE groups (median abnormal tests no-HE/HN: 3, HN: 3.5, HE: 6.5, HE + HN: 7, p = 0.008). Despite better cognition, HN only patients had worse HRQOL in total and psychosocial SIP while both HN groups (with/without HE) had a significantly worse physical SIP (p < 0.0001, all comparisons). Brain MRS showed the lowest Glx in HN and the highest in HE groups (p < 0.02). mI levels were comparably decreased in the three affected (HE, HE + HN, and HN) groups compared to no HE/HN and were associated with poor HRQOL. Six HE + HN cirrhotics underwent diuretic withdrawal which improved serum sodium and total/psychosocial SIP scores.Conclusions: Hyponatremic cirrhotics without HE have poor HRQOL despite better cognition than those with concomitant HE. Glx levels were lowest in HN without HE but mI was similar across affected groups. HRQOL improved after diuretic withdrawal. Hyponatremia has a complex, non-linear relationship with brain Glx and mI, cognition and HRQOL. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.