J. Hepatol.：肝硬化合并肝性脑病患者更易发生颅骨骨折

肝性脑病（HE）是肝硬化患者的可逆性神经精神疾病。由HE导致的认知障碍和意外跌倒的增加，以及肝硬化造成的骨营养不良，可能共同促进了骨折的发生。先前有关骨折发生风险的研究主要是小规模的病例对照研究，但缺少关于骨折发生率的信息和细节。对于骨折发生率、发生位置以及相关医疗成本的进一步研究，或许有助于设计更好的预防策略。基于上述情况，来自台湾国立阳明大学医学院及台北荣民总医院的医学博士Chia-Fen Tsai等人展开一项研究，研究结果在线发表在2012年12月11日的《肝脏病学杂志》（Journal of Hepatology）上。研究人员发现，肝硬化合并HE患者更容易发生颅骨骨折。

该研究的目的是调查肝硬化合并HE患者骨折的发生率和危险因素。总共从台湾全民健康保险数据库获取了2000年至2009年间3764例肝硬化合并HE患者的资料。并比较分析了与HE患者在年龄、性别及并存病方面均匹配的3764例肝硬化无HE患者和无肝硬化对照患者骨折的发生率。最后采用Cox比例风险模型评估HE患者发生骨折的风险。

研究结果如下，与对照组相比，肝硬化合并HE患者与肝硬化无HE患者同等地增加了骨折的发生风险（P<0.05）和骨折的累计发生率（log-rank P<0.001）。在18个月的随访期间进行评估， HE组骨折发生率为7.09%，肝硬化无HE组为7.72%，对照组为4.05%。与肝硬化无HE组相比，HE 组颅骨骨折的发生率更高（发病率比[IRR]=2.61，95%置信区间[CI]：1.04-6.57），上肢骨折的发生率更低（IRR=0.45，95%CI：0.29-0.70）。酗酒、心力衰竭和脑血管疾病均与HE患者骨折发生风险的增加相关。

研究发现，肝硬化患者，不论是否合并HE，尽管发生骨折的位置有所不同，但是发生骨折的风险均显着增加。并存病，例如酗酒、心力衰竭和脑血管疾病，是HE患者发生骨折的独立危险因素。HE患者，尤其是那些具有并存病的患者，更容易发生颅骨骨折，而不是承重骨骨折。或许应该采取相应的预防措施以降低HE患者发生骨折的风险。

与肝硬化相关的拓展阅读：

• J Hepatol：NSBB治疗降低肝硬化患者肠粘膜通透性
• CID：HCV相关肝硬化患者实现SVR后仍长期处于肝细胞癌风险中
• AJG：肝硬化门静脉血栓形成预测因素
• Hepatology：丙肝肝硬化大多因酗酒导致
• J Hepatol：肝硬化患者骨折风险增高 更多信息请点击：有关肝硬化更多资讯

Increased incidence of orthopedic fractures in cirrhotic patients: A nationwide population-based study.
BACKGROUND & AIMS
Hepatic encephalopathy (HE) is a reversible neuropsychiatric disorder in cirrhotic patients. The cognitive dysfunction and increased accidental falls in HE and osteodystrophy in cirrhotic patients may contribute to orthopedic fractures. This study investigated the fracture incidence and risk factors in cirrhotic patients with HE.
METHODS
In total, 3764 cirrhotic patients with HE were identified from the Taiwan National Health Insurance database between 2000 and 2009. The fracture incidence of the HE patients was compared with that of 3764 age-, sex-, and comorbidity-matched cirrhotic patients without HE and non-cirrhotic controls. Cox proportional hazard models were used to estimate the risk of fracture in the HE patients.
RESULTS
Cirrhotic patients with and without HE had comparable increased risks of fracture (p <0.05) and cumulative incidences of fracture than controls (log-rank p <0.001). The estimated fracture rates were 7.09% for the HE group, 7.72% for the cirrhosis without HE group, and 4.05% for the controls, during the 18-month follow-up. The HE group had a higher incidence rate of skull fractures (IRR=2.61, 95% CI 1.04-6.57), but a lower rate of upper limb fractures (IRR=0.45, 95% CI 0.29-0.70) than the cirrhosis without HE group. Alcoholism, heart failure, and cerebrovascular disease were associated with increased risk of fracture in HE patients.
CONCLUSIONS
Cirrhotic patients, with or without HE, are at an increased risk of orthopedic fractures. Skull fractures, rather than fractures in weight-bearing bones, are more frequently observed in HE patients, particularly those with comorbidities.