Clinical aspects of asthenic syndrome in non-alcoholic fatty liver disease
https://doi.org/10.31146/1682-8658-ecg-240-8-41-46
Abstract
Asthenic syndrome is often present in the clinical picture of non-alcoholic fatty liver disease (NAFLD). The aim of the study was to clarify the clinical manifestations of asthenic syndrome in NAFLD, their severity depending on the stage of the pathological process in the liver. Materials and methods: 64 patients with NAFLD and 15 individuals who do not suffer from this pathology were examined. Clinical examination, ultrasound examination of the abdominal cavity, esophagogastroduodenoscopy, and blood tests were performed. All patients were divided into 3 groups: 49 patients with hepatic steatosis, 15 with steatohepatitis, and 15 with a control group. Results. It was found that at the stage of liver steatosis almost half of the patients had emotional lability, increased anxiety, and irritability. Sleep changes were less frequently detected: daytime and early evening drowsiness (31%), poor sleep (37%). Cognitive impairments were characterized by decreased attention (31%) and memory (29%). In the group of patients with steatohepatitis, 60% of the examined patients had mood instability, increased irritability and anxiety, and 33% had depression. Sleep disorders were often detected, and symptoms such as intermittent sleep, fatigue after sleep, "heavy" awakening, and fatigue in the morning were present. Cognitive impairments in the form of decreased memory and attention were detected in more than half of the patients in this group, and a third of the patients reported an inability to quickly switch attention. Symptoms of asthenic syndrome in patients of the control group occurred in a small percentage of cases or were absent. Conclusion. Asthenic syndrome always been present in patients with NAFLD with greater symptoms of steatohepatitis. Given the somatic nature of asthenic syndrome, treatment should primarily be aimed at correcting the underlying pathology, namely NAFLD with an emphasis on a healthy lifestyle.
About the Author
L. A. Fomina
Tver State Medical University of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
References
1. Povsic M., Wong O. Y., Perry R., Bottomley J. A Structured Literature Review of the Epidemiology and Disease Burden of Non- Alcoholic Steatohepatitis (NASH). Adv Ther. 2019;36(7):1574-94. doi: 10.1007/s12325-019-00960-3.
2. Ivashkin V. T., Drapkina O. M., Mayev I. V. et al. Prevalence of non-alcoholic fatty liver disease in out-patients of the Russian Federation: DIREG 2 study results.Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2015;25(6):31-41. (In Russ.)@@ Ивашкин В. Т., Драпкина О. М., Маев И. В. и соавт. Распространенность неалкогольной жировой болезни печени у пациентов амбулаторно-поликлинической практики в Российской Федерации: результаты исследования DIREG 2. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2015;25(6):31-41.
3. Evstifeeva S. E., Shalnova S. A., Kutsenko V. A. et al. Prevalence of non-alcoholic fatty liver disease among the working-age population: associations with socio-demographic indicators and behavioral risk factors (ESSE RF-2 data). Cardiovascular Therapy and Prevention. 2022;21(9):3356. (In Russ.) doi: 10.15829/ 1728-8800-2022-3356.@@ Евстифеева С. Е., Шальнова С. А., Куценко В. А. и соавт. Распространенность неалкогольной жировой болезни печени среди населения трудоспособного возраста: ассоциации с социально-демографическими показателями и поведенческими факторами риска (данные ЭССЕ-РФ-2). Кардиоваскулярная терапия и профилактика. 2022;21(9):3356. doi: 10.15829/1728-8800-2022-3356.
4. Estes C., Anstee Q. M., Arias-Loste M. T. et al. Modeling NAFLD disease burden in China, France, ermany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. Hepatology. 2018;69:896-904. doi: 10.1016/j.jhep.2018.05.036.
5. Jichitu A., Bungau S., Stanescu A. M.A. et al. Non-Alcoholic Fatty Liver Disease and Cardiovascular Comorbidities: Pathophysiological Links, Diagnosis, and Therapeutic Management. Diagnostics (Basel). 2021;11(4):689. doi: 10.3390/diagnostics11040689.
6. Birkenfeld A. L., Shulman G. I. Nonalcoholic fatty liver disease, hepatic insulin resistance, and type 2 diabetes. Hepatology. 2014;59:713-23. doi: 10.1002/hep.26672.
7. Targher G., Byrne C. D. Non-alcoholic fatty liver disease: an emerging driving force in chronic kidney disease. Nat Rev Nephrol. 2017;13:297-310. doi: 10.1038/nrneph.2017.16.
8. Livzan M. A., Gaus O. V., Nikolaev N. A., Krolevetz T. S. NAFLD: comorbidity and associated diseases. Experimental and Clinical Gastroenterology. 2019;170(10): 57-65. (In Russ.) doi: 10.31146/1682-8658-ecg-170-10-57-65.@@ Ливзан М. А., Гаус О. В., Николаев Н. А., Кролевец Т. С. НАЖБП: коморбидность и ассоциированные заболевания. Экспериментальная и клиническая гастроэнтерология. 2019;170(10): 57-65. doi: 10.31146/1682-8658-ecg-170-10-57-65.
9. Nelidova A. V., Livzan M. A., Nikolaev N. A., Krolevets T. S. Cardiovascular Diseases and Non-Alcoholic Fatty Liver Disease: Relationship and Pathogenetic Aspects of Pharmacotherapy. Rational Pharmacotherapy in Cardiology. 2021;17(6):880-888. (In Russ.) doi: 10.20996/1819-6446-2021-12-14.@@ Нелидова А. В., Ливзан М. А., Николаев Н. А., Кролевец Т. С. Сердечно-сосудистые заболевания и неалкогольная жировая болезнь печени: связь и патогенетические аспекты фармакотерапии. Рациональная Фармакотерапия в Кардиологии. 2021;17(6):880-888. doi: 10.20996/1819-6446-2021-12-14.
10. Basaranoglu M., Neuschwander-Tetri B. A. Nonalcoholic Fatty Liver Disease: Clinical Features and Pathogenesis. Gastroenterol Hepatol. 2006;2(4):282-291. PMID: 28286458.
11. Tsukanov V. V., Osipenko M. F., Beloborodova E. V. et al. Practical Aspects of Clinical Manifestations, Pathogenesis and Therapy of Alcoholic Liver Disease and Non-alcoholic Fatty Liver Disease: Expert Opinion.Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2023;33(4):7-13. (In Russ.) doi: 10.22416/1382-4376-2023-33-4-7-13.@@ Цуканов В. В., Осипенко М. Ф., Белобородова Е. В. и соавт. Практические аспекты клинических проявлений, патогенеза и терапии алкогольной болезни печени и неалкогольной жировой болезни печени: мнение экспертов. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2023;33(4):7-13. doi: 10.22416/1382-4376-2023-33-4-7-13.
12. Drapkina О. М., Korneeva О. N. Continuum of non-alcoholic fatty liver disease: from hepatic steatosis to cardiovascular risk. Rational pharmacotherapy in cardiology. 2016;12(4):424-429. (In Russ.) doi: 10/20996/1819-6446-2016-12-4-424-429.@@ Драпкина О. М., Крнеева О. Н. Континиум неалкогольной жировой болезни печени: от стеатоза печени до сердечно-сосудистого риска. Рациональная фармакотерапия в кардиологии 2016;12(4):424-429. doi: 10/20996/1819-6446-2016-12-4-424-429.
13. Swain M. G. Fatigue in liver disease: pathophysiology and clinical management. Can J Gastroenterol. 2006;20(3):181-188. doi: 10.1155/2006/624832.
14. Austin P. W., Gerber L., Karrar A. K. Fatigue in chronic liver disease: exploring the role of the autonomic nervous system. Liver Int. 2015;35(5):1489-1491. doi: 10.1111/liv.12784.
15. Newton J. L. Systemic symptoms in non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):214-219. doi: 10.1159/000282089.
16. Efremova O. A., Ruzhenkov V. A., Yaroshenko E. E., Mitin M. S. Astheno-vegetative syndrome at patients with the chronic virus hepatitis. Scientific Vedomosti of Belgorod University. 2011;22(117):119-27.(In Russ.)@@ Ефремова О. А., Руженков В. А., Ярошенко Е. Е., Митин М. С. Распространенность вегетативной дисфункции и астении у больных хроническим вирусным гепатитом. Научные ведомости БелГ У. 2011;22(117):119-27.
17. Plotnikovа E. Y., Baranova E. N., Shamrai M. A. et al. Chronic hepatitis - clinical and vegetative features. Experimental and Clinical Gastroenterology. 2014;8(108):66-70. (In Russ.)@@ Плотникова Е. Ю., Баранова Е. Н., Шамрай М. А. и соавт. Хронический гепатит С - клинико-вегетативные особенности. Экспериментальная и клиническая гастроэнтерология. 2014;8(108):66-70.
18. Plotnikova E.Yu., Sinkova M. N., Isakov L. K. Asthenia and fatigue in hyperammonemia: etiopathogenesis and methods of correction. Meditsinskiy sovet. 2021;21(1):95-104. (In Russ.) doi: 10.21518/2079-701X-2021-21-1-95-104.@@ Плотникова Е. Ю., Синькова М. Н., Исаков Л. К. Астения и утомление при гипераммониемии: этиопатогенез и методы коррекции. Медицинский совет. 2021; 21(1):95-104. doi: 10.21518/2079-701X-2021-21-1-95-104.
19. Upadhyay R., Bleck T. P., Busl K. M. Hyperammonemia: What Urea-lly Need to Know: Case Report of Severe Noncirrhotic Hyperammonemic Encephalopathy and Review of the Literature. Case Rep Med. 2016; 2016:8512721. (In Russ.) doi: 10.1155/2016/8512721.
20. Dam G., Keiding S., Munk O. L. et al. Hepatic encephalopathy is associated with decreased cerebral oxygen metabolism and blood flow, not increased ammonia uptake. Hepatology. 2013;57(1):258-265. doi: 10.1002/hep.25995.
21. Salerno F., Cazzaniga M. Autonomic dysfunction: often present but usually ignored in patients with liver disease. Liver Int. 2009;29(10):1451-53. doi: 10.1111/j.1478-3231.2009.02141.x.
22. Swain M. G., Jones D. E.J. Fatigue in chronic liver disease: New insights and therapeutic approaches. Liver Int. 2019;39(1):6-19. doi: 10.1111/liv.13919.
23. Oganezova I. A. Asthenia as a Systemic Manifestation of Chronic Liver diseases: Fundamentals of pathophysiology and therapeutic possibilities. Pharmateca. 2018; 9;73-78. (In Russ.) doi: 10.18565/pharmateca.2018.9.73-78.@@ Оганезова И. А. Астения как системное проявление хронических заболеваний печени: основы патофизиологии и возможности терапии. Фарматека. 2018; 9; 73-78. doi: 10.18565/pharmateca.2018.9.73-78.
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For citations:
Fomina L.A. Clinical aspects of asthenic syndrome in non-alcoholic fatty liver disease. Experimental and Clinical Gastroenterology. 2025;(8):41-46. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-240-8-41-46
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