Lviv clinical bulletin 2014, 4(8): 19-23

https://doi.org/10.25040/lkv2014.04.019

State of the Autonomic Nervous System in Patients with the Different Severity Stages of Cirrhosis of the Liver

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O. Abrahamovych, M. Abrahamovych, S. Tolopko, M. Ferko, O. Fayura

Danylo Halytsky Lviv National Medical University

Introduction. A problem of the occurrence and course of liver cirrhosis (LC) and its severity increase is one of the most difficult in modern gastroenterology. An important place in the pathogenesis of LC, the course of the disease and its prognosis takes the state of the autonomic nervous system (ANS). It is known that the disorders of the ANS state is one of the pathogenetic mechanisms of the appearance and increase of the severity of LC, due to the exclusion of the central regulatory mechanisms of life processes with the transition to the lowest level – humoral-metabolic, which is an unfavorable prognostic sign. However the features of ANS state f, in spite of its important role in the human organism, are not sufficiently studied.

Aim. To find out the ANS state in cirrhotic patients with the different degree of the severity.

Materials and methods. In order to assess the state of the ANS we have conducted a comprehensive clinical and laboratory examination of 93 patients with LCand studied its basic functional and dynamic indices: tone, autonomic reactivity, autonomic support of the organism functioning, using the questionnaire of A. M. Wein, clinical criteria of A. D. Solovyov, functional tests: thermal, cold, Tom-Roux, orthoclinostatic and registration of heart rate variability.

Results. According to the results of A. M. Wein’s questionnaire, the most often symptoms of the autonomic disorders were met in the patients of C class (by C. G. Child-R. N. Pugh). According to the results of the medical examination, in obedience to the criteria of A. D. Solovyov, the tone of the sympathetic nervous system (SNS) prevailed in all groups of the patients: for the persons of class A – on 30.0 %, B – on 44.0 %, C – on 51.6 % and for the control group (CG) – on 3.0 %, comparing with the tone of the parasympathetic nervous system (PSNS).

Consequently, the conducted studies have allowed us to diagnose the disorders of ANS in all the patients with LC, severity of which significantly increases with the disease decompensation. In all the people SNS tone has prevailed with a tendency to hypertone with increasing of the pathological process severity, indicating the activation of compensatory capacity of the organism to maintenance homeostasis in case of portal hypertension. Results, received after the conducting of cold test, testify, that comparatively to the CG, in most persons of class A (91.3 %) hyperreactivity of the ANS is diagnosed more frequently (p < 0.001), that is in 74.5 and 91.3 % of the persons of classes B and C accordingly (p < 0.001). The results of thermal, orthoclinostatic, Tom-Roux’s probes confirm the indices, got during the conducting of the cold test. The results of the thermal, orthoclinostatic and Tom- Roux’s tests were confirmed by the indices, received during the cold test.

Also, during the record of the heart rate variability without stress the indices of the general spectral power (TP), in patients of class A (923.4 ± 191.3 mc2/Hz), B (935.9 ± 139.4 mc2/Hz) and C (203.4 ± 301.9 mc2/Hz) were significantly (p < 0.001) lower than in the CG (3243.8 ± 46.2 mc2/Hz). In the patients of class C the indices of TP were significantly lower comparing with class A (p < 0.001) and B (p < 0.001) with the tendency to the decrease with the increase of severity class. It testifies the strengthening of the SNS influence, however not reflect the structure of the organism regulation levels. The results, got during the conducting of the orthostatic test, confirmed the indices, got before the stress.

Conclusions. The results allowed us to diagnose the presence of autonomic disorders in 100.0 % of the patients, with the superior effects of the sympathetic part of the autonomic nervous system over the parasympathetic with the directly proportional increase of the neuro-humoral effects according to the severity of the pathological process in the liver. The study of the correlation between the indices of heart rate variability and classes of liver cirrhosis by C. G. Child-R. N. Pugh lets us recommend them to predict the disease course.

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