Karaciğer Sirozunda Yorgunluk, Kas Kuvveti ve Kas Oksijenasyonu İlişkisi

Abstract

Amaç: Çalışmamızın amacı; karaciğer sirozu olan hastalarda yorgunluk şiddeti, kas kuvveti ve kas oksijenasyonu arasındaki ilişkinin incelenmesidir. Yöntem: En az bir senedir karaciğer sirozu tanısı ile takip edilen 35-75 yaş aralığındaki hastalar çalışmaya dahil edildi. Katılımcıların Model for End-Stage Liver Disease (MELD) ve Child-Pugh-Turcotte (CPT) skorları hesaplandı. Olguların yorgunluk düzeyleri Yorgunluk Şiddet Ölçeği ile değerlendirildi. M. Quadriceps kas kuvveti dijital el dinamometresi ile ölçüldü. Kas oksijenasyonu, Yakın Kızılötesi Spektroskopisi modeli kullanılarak değerlendirildi. Olguların istirahatte m. vastus medialis kasına sabitlenen monitör kas oksijenasyonu ölçümü için kullanıldı. Bulgular: Çalışmamıza 25 karaciğer sirozu hastası (12 K, 13 E) dahil edildi. Olguların MELD ve CPT skorları ile yorgunluk şiddeti, kas kuvveti ve oksijenasyonu arasında bir ilişki yoktu (p>0,05). Karaciğer sirozu hastalarının yorgunluk şiddetleri ile m. quadriceps kuvveti ve kas oksijenasyonu arasında negatif yönde orta düzeyde ilişki bulundu (r=-0,429, p= 0,032; r=-0,468, p=0,018). Sonuç: Karaciğer sirozu hastalarında hissedilen yorgunluk şiddeti, kas kuvveti ve kas oksijenasyonu ile ilişkilidir. Çalışmamızın sonuçlarına göre, daha yüksek kas kuvveti ve kas oksijenasyonu, daha düşük şiddetli yorgunluğa işaret etmektedir. Çalışmamız, kronik karaciğer hastalarının egzersiz kapasite ve kas kuvvetinin artırılması, fiziksel aktivite seviyelerinin geliştirilmesi ve yaşam kalitesine olumlu etkiler sağlayacak fizyoterapi ve rehabilitasyon programlarının planlanmasına katkı sağlayacaktır.

Keywords

• Karaciğer sirozu
• Kas kuvveti
• Yorgunluk

Relationship between fatigue, muscle strength, and muscle oxygenation in liver cirrhosis

Abstract

Purpose: This study was aimed to investigate the relationship between fatigue severity, muscle strength, and muscle oxygenation in patients with liver cirrhosis. Methods: A total of 25 patients with liver cirrhosis (12 female, 13 male) were included in our study. Patients aged 35-75 years who have been followed with a diagnosis of liver cirrhosis for at least one year were included in the study. The participants' Model for End-Stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) scores were calculated. The fatigue levels of the cases were assessed using the Fatigue Severity Scale. M. Quadriceps femoris strength was measured with a digital hand dynamometer. Muscle oxygenation was evaluated using the Near-Infrared Spectroscopy model. The monitor fixed to the vastus medialis muscle at rest was used for muscle oxygenation measurement in the cases. Results: There was no relationship between MELD and CPT scores and fatigue severity, muscle strength, and oxygenation (p>0.05). A moderate negative correlation was found between fatigue severity and quadriceps muscle strength and oxygenation in patients with liver cirrhosis (r=-0.429, p=0.032; r=-0.468, p=0.018). Conclusion: The fatigue severity experienced in patients with liver cirrhosis is related to muscle strength and muscle oxygenation. According to the results of our study, higher muscle strength and muscle oxygenation indicate less severe fatigue. These findings suggest that increasing muscle strength and muscle oxygenation may reduce fatigue severity in patients with liver cirrhosis. Regular physical activity and exercise programs are predicted to have positive effects on reducing fatigue by increasing muscle strength and oxygenation in this population.

Keywords

• Liver cirrhosis
• Muscle strength
• Fatigue

References

1. Değertekin B, Tözün N. Sirozda Patogenez ve Patoloji. Turkiye Klinikleri Gastroenterohepatology-Special Topics. 2013;6:5-12.
2. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-851.
3. Premkumar M, Anand AC. Overview of complications in cirrhosis. J Clin Exp Hepatol. 2022;12:1150-1174.
4. Jacobsen EB, Hamberg O, Quistorff B, et al. Reduced mitochondrial adenosine triphosphate synthesis in skeletal muscle in patients with Child-Pugh class B and C cirrhosis. Hepatology. 2001;34:7-12.
5. Poynard T, Cacoub P, Ratziu V, et al. Fatigue in patients with chronic hepatitis C. J Viral Hepat. 2002;9:295-303.
6. Swain MG, Jones DEJ. Fatigue in chronic liver disease: New insights and therapeutic approaches. Liver Int. 2019;39:6-19.
7. Newton JL. Systemic symptoms in non-alcoholic fatty liver disease. Dig Dis. 2010;28:214-219.
8. Gerber LH, Weinstein AA, Mehta R, et al. Importance of fatigue and its measurement in chronic liver disease. World J Gastroenterol. 2019;25:3669-3683.

9. Lima YB, Mota MC, Garcia JHP, et al. Association between fatigue and exercise capacity in patients with chronic liver disease awaiting liver transplantation. Arq Gastroenterol. 2019;30:252-255.
10. Montano-Loza AJ, Meza-Junco J, Prado CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10:166-173.
11. Tsoris A, Marlar CA. Use of The Child Pugh Score in Liver Disease. 2023 Mar 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. PMID: 31194448.
12. Emenena I, Emenena B, Kweki AG, et al. Model for End Stage Liver Disease (MELD) Score: A tool for prognosis and prediction of mortality in patients with decompensated liver cirrhosis. Cureus. 2023;15:e39267.
13. Lee DH, Son JH, Kim TW. New scoring systems for severity outcome of liver cirrhosis and hepatocellular carcinoma: current issues concerning the Child-Turcotte-Pugh score and the Model of End-Stage Liver Disease (MELD) score. Taehan Kan Hakhoe Chi. 2003;9:167-179.
14. Acharya G, Kaushik RM, Gupta R, et al. Child-Turcotte-Pugh Score, MELD Score and MELD-Na Score as Predictors of Short-Term Mortality among Patients with End-Stage Liver Disease in Northern India. Inflamm Intest Dis. 2020;5:1-10.
15. Armutlu K, Korkmaz NC, Keser I, Sumbuloglu V, et al. The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients. Int J Rehabil Res. 2007;30:81-85.
16. Krupp LB, Coyle PK, Doscher C, et al. Fatigue therapy in multiple sclerosis: results of a double-blind, randomized, parallel trial of amantadine, pemoline, and placebo. Neurology. 1995;45:1956-1961.
17. Mentiplay BF, Perraton LG, Bower KJ, et al. Assessment of Lower Limb Muscle Strength and Power Using Hand-Held and Fixed Dynamometry: A Reliability and Validity Study. PLoS One. 2015;10:e0140822.
18. McKay MJ, Baldwin J, Ferreira P, et al. Normative reference values for strength and flexibility of 1,000 children and adults. Neurology. 2017;3:36-43.
19. Yogev A, Arnold J, Nelson H, et al. Comparing the reliability of muscle oxygen saturation with common performance and physiological markers across cycling exercise intensity. Front Sports Act Living. 2023;5:1143393.
20. Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126:1763-1768.
21. Ekerfors U, Sakin K, Westin J, et al. Muscle performance and fatigue in compensated chronic liver disease. Scand J Gastroenterol. 2019:925-933.
22. Taskin Gurel B, Vardar Yagli N, Calik Kutukcu E, et al. Long-term declines in physical fitness and physical activity for ındividuals with post-liver transplantation compared to healthy controls. Percept Mot Skills. 2023;130:2450-2464.
23. Van den Berg-Emons R, van Ginneken BT, Wijffels M, et al. Fatigue is a major problem after liver transplantation. Liver Transpl. 2006;12:928-933.
24. Zenith L, Ma N, Ramadi A, et al. Eight weeks of exercise training increases aerobic capacity and muscle mass and reduces fatigue In patients with cirrhosis. Clin Gastroenterol Hepatol. 2014;12:1920-1926.
25. Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transpl. 2012;18:146-151.
26. Aamann L, Dam G, Borre M, et al. Resistance training increases muscle strength and muscle size in patients with liver cirrhosis. Clin Gastroenterol Hepatol. 2020;18:1179-1187.
27. McDaniel J, Davis G, Hill EA, et al. Hyperammonemia results in reduced muscle function independent of muscle mass. Am J Physiol Gastrointest Liver Physiol. 2016;310:163-170.
28. Thomson SJ, Cowan ML, Forton DM, et al. A study of muscle tissue oxygenation and peripheral microcirculatory dysfunction in cirrhosis using near infrared spectroscopy. Liver Int. 2010;30:463-471.
29. García-Pagán JC, Gracia-Sancho J, Bosch J. Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol. 2012;57:458-461.