Gait disorders and muscle changes in patients with liver cirrhosis: analysis of electroneurographic data of a subgroup of patients with and without cognitive impairment

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.016
L. Ridola , J. Faccioli , S. Nardelli , S. Gioia , S. Elia , S.F. Castiglia , M. Serrao
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Abstract

Hepatic encephalopathy (HE) is a common complication of liver cirrhosis and minimal HE (MHE) increases the risk of falls. Gait alterations in cirrhotic patients are poorly understood, so the aims of this study is to describe the correlation between clinical parameters, such as HE, muscle changes, falls and gait disturbances, and electroneurographic changes.

Twenty-six patients underwent clinical and medical history evaluation to assess the presence of MHE and falls in the past year, and biochemical and instrumental evaluation to determine the presence of gait disturbances or sarcopenia by computed tomography (CT). Gait was assessed with the six-minute walk test (6MWT), the G-Walk device and G-STUDIO software. Ten patients underwent electroneurographic examination (ENG). Data obtained from gait analysis were compared with healthy subjects of the same age and sex.

In the gait analysis, the harmonic ratio (HR) and the recurrence quantification analysis (RQA) were considered. HR provides information on movement fluidity, balance and body coordination during movement, while RQA is based on the identification of parameters that quantify the regularity of time series.

In the subgroup of patients undergoing ENG analysis, lower values of HR in the antero-posterior and vertical directions correlated with the presence of sensory (τbAP= -0.629, p=0.039; τbV= -0.707, p=0.020) and motor (τbAP= -0.707, p=0.020; τbV= -0.629, p=0.039) neuropathy. The highest worsening of RQA index after 6MWT in vertical direction correlated with the presence of motor neuropathy (τbDET= 0.550, p=0.035). The number of falls correlated with sensory and motor electroneurographic parameters, while MELD score was inversely correlated with sensory and motor conduction velocity (ρ=-0.590, p= 0.047; ρ=-0.896, p= 0.003) and directly correlated with motor latency (ρ= 0.783, p= 0.013). Psychometric hepatic encephalopathy score (PHES) values were inversely correlated with distal motor latency signals (ρ=0.854, p= 0.003), while skeletal muscle index (SMI) values were found to be inversely correlated with proximal motor latency (ρ=0.802, p= 0.005).

Gait alterations are common in patients with cirrhosis, especially those with cognitive impairment, and correlate with severity of disease and risk of falls, identifying patients at risk of injuries and hospitalizations.

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肝硬化患者的步态障碍和肌肉变化:有认知障碍和无认知障碍亚组患者的电神经图学数据分析
肝性脑病(HE)是肝硬化的常见并发症,而轻度肝性脑病(MHE)会增加跌倒的风险。这项研究旨在描述肝性脑病、肌肉变化、跌倒和步态障碍等临床参数与电神经图学变化之间的相关性。26 名患者接受了临床和病史评估,以评估过去一年中是否存在肝性脑病和跌倒,并接受了生化和仪器评估,以通过计算机断层扫描(CT)确定是否存在步态障碍或肌肉疏松症。步态通过六分钟步行测试(6MWT)、G-Walk 设备和 G-STUDIO 软件进行评估。十名患者接受了电神经图学检查(ENG)。步态分析获得的数据与同年龄、同性别的健康人进行了比较。谐波比值提供了运动过程中的动作流畅性、平衡性和身体协调性的信息,而复发量化分析则是基于对时间序列规律性参数的识别。在接受ENG分析的亚组患者中,前后方向和垂直方向较低的HR值与存在感觉神经病变(τbAP= -0.629,p=0.039;τbV= -0.707,p=0.020)和运动神经病变(τbAP= -0.707,p=0.020;τbV= -0.629,p=0.039)相关。在垂直方向进行 6MWT 后,RQA 指数的恶化程度最高,这与运动神经病变有关(τbDET= 0.550,p=0.035)。跌倒次数与感觉和运动神经电图参数相关,而MELD评分与感觉和运动传导速度成反比(ρ=-0.590,p= 0.047;ρ=-0.896,p= 0.003),与运动潜伏期直接相关(ρ= 0.783,p= 0.013)。肝性脑病心理评分(PHES)值与远端运动潜伏期信号成反比(ρ=0.854,p= 0.003),而骨骼肌指数(SMI)值与近端运动潜伏期成反比(ρ=0.步态改变在肝硬化患者,尤其是认知障碍患者中很常见,与疾病严重程度和跌倒风险相关,可识别有受伤和住院风险的患者。
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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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