慢性肝病的疲劳：新见解和治疗方法

StephenW

Fatigue in chronic liver disease: New insights and therapeutic approaches
Mark G Swain
David E J Jones
First published: 23 June 2018
https://doi.org/10.1111/liv.13919

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/liv.13919

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Abstract

The management of fatigue associated with chronic liver disease is a complex and major clinical challenge. Although fatigue can complicate many chronic diseases, it is particularly common in diseases with an inflammatory component. Fatigue can have both peripheral (i.e., neuromuscular) and central (i.e., resulting from changes in neurotransmission within the brain) causes. However, fatigue in chronic liver disease has strong social/contextual components and is often associated with behavioural alterations including depression and anxiety. Given the increasing awareness of patient‐reported outcomes as important components of treatment outcomes and clinical research, there is a growing need to better understand and manage this poorly understood yet debilitating symptom. Although several pathophysiological mechanisms for explaining the development of fatigue have been generated, our understanding of fatigue in patients with chronic liver disease remains incomplete. A better understanding of the pathways and neurotransmitter systems involved may provide specific directed therapies. Currently, the management of fatigue in chronic liver disease can involve a combined use of methods to beneficially alter behavioural components and pharmacological interventions, of which several treatments have potential for the improved management of fatigue in chronic liver disease. However, evidence and consensus are lacking on the best approach and the most appropriate biochemical target(s) whilst clinical trials to address this issue have been few and limited by small sample size. In this review, we outline current understanding of the impact of fatigue and related symptoms in chronic liver disease, discuss theories of pathogenesis, and examine current and emerging approaches to its treatment.

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StephenW

慢性肝病的疲劳：新见解和治疗方法
Mark G Swain
大卫E琼斯
首次出版：2018年6月23日
https://doi.org/10.1111/liv.13919

本文已被接受发表，并未经作者，分页和校对过程公布，导致本版本与“版本记录”存在差异。请引用这篇文章作为doi：10.1111 / liv.13919

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摘要

疲劳管理是一项复杂而重大的临床挑战。尽管疲劳会使许多慢性疾病复杂化，但它在炎症成分疾病中尤为常见。疲劳可以是外周（即，神经肌肉）和中枢（即由大脑内神经传递的变化引起的）原因。然而，慢性肝病的疲劳与行为问题有关。鉴于患者报告的结果越来越被认为是治疗结果和临床研究的重要组成部分，因此越来越需要了解和管理这种了解甚少但令人虚弱的症状。虽然已经产生了几种发展疲劳的病理生理学机制，但我们对慢性肝病患者疲劳的理解仍然不完整。更好地理解所涉及的途径和神经递质系统可以提供特定的定向治疗。目前，慢性肝病疲劳的治疗可以用于治疗各种功能和药物干预。然而，在解决这个问题的临床试验中，最好的方法和最合适的生化目标缺乏证据和共识。在这篇综述中，我们讨论目前对慢性疾病疲劳和相关症状影响的理解，讨论发病机制理论，并讨论当前和新兴的治疗方法。

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遥望曙光

感觉确实比健康人易疲劳