ABSTRACT

Background and Aims

Lipid metabolism is often disrupted in liver cirrhosis. The present study aimed to evaluate the impact of lipid profile on decompensation events, severity of liver dysfunction, and death in patients with liver cirrhosis.

Methods

In a cross-sectional study, 778 patients with lipid profile data were enrolled, and then were divided into 240 and 538 patients with and without liver cirrhosis, respectively. In a cohort study, 314 cirrhotic patients with lipid profile data, who were prospectively followed, were enrolled. Lipid profile included total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), triglycerides (TG), and lipoprotein(a).

Results

In the cross-sectional study, cirrhotic patients with decompensation events had significantly lower levels of TC and lipoprotein(a) than those without; and cirrhotic patients with Child-Pugh class B and C had significantly lower levels of TC, HDL-c, LDL-c, and lipoprotein(a) than those with Child-Pugh class A. In the cohort study, there was an inverse association of survival with TC, HDL-c, and lipoprotein(a) levels; after adjusting for MELD score, TC (Hazard Ratio [HR] = 1.703, P = 0.034) and HDL-c (HR = 2.036, P = 0.005), but not lipoprotein(a) (HR = 1.377, P = 0.191), remained a significant predictor of death; when TC, HDL-c, lipoprotein(a), and MELD score were included in the multivariate Cox regression analysis, HDL-c (HR = 1.844, P = 0.024) was the only independent predictor of death.

Conclusions

Decreased levels in specific components of lipid profile indicate more decompensation events, worse liver function, and reduced survival in liver cirrhosis. MELD score combined with HDL-c should be promising for the assessment of outcomes of cirrhotic patients.

中文翻译：

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肝硬化患者血脂与失代偿、肝功能障碍和死亡率的关系

摘要

背景和目标

在肝硬化中脂质代谢经常被破坏。本研究旨在评估血脂对肝硬化患者失代偿事件、肝功能障碍严重程度和死亡的影响。

方法

在一项横断面研究中，778 名有血脂数据的患者入组，然后分别分为 240 名和 538 名有肝硬化和无肝硬化的患者。在一项队列研究中，314 名具有血脂数据的肝硬化患者被纳入前瞻性随访。脂质谱包括总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL-c)、低密度脂蛋白胆固醇 (LDL-c)、甘油三酯 (TG) 和脂蛋白 (a)。

结果

在横断面研究中，发生失代偿事件的肝硬化患者的 TC 和脂蛋白 (a) 水平显着低于未发生失代偿事件的患者；Child-Pugh B 级和 C 级肝硬化患者的 TC、HDL-c、LDL-c 和脂蛋白 (a) 水平显着低于 Child-Pugh A 级患者。在队列研究中，存在负相关TC、HDL-c 和脂蛋白 (a) 水平的生存率；在调整 MELD 评分后，TC（危险比 [HR] = 1.703，P = 0.034）和 HDL-c（HR = 2.036，P = 0.005），但不是脂蛋白（a）（HR = 1.377，P = 0.191），仍然是死亡的重要预测因素；当 TC、HDL-c、脂蛋白 (a) 和 MELD 评分被纳入多变量 Cox 回归分析时，HDL-c (HR = 1.844, P = 0.024) 是唯一的死亡独立预测因子。

结论

脂质谱特定成分水平的降低表明更多的失代偿事件、更差的肝功能以及肝硬化患者的存活率降低。MELD 评分与 HDL-c 相结合应该有望用于评估肝硬化患者的预后。