Prevalence and risk factors of lymphatic dysfunction in cirrhosis patients with refractory ascites:An often unconsidered mechanism  

作　　者：Rahul Arya Ramesh Kumar Tarun Kumar Sudhir Kumar Utpal Anand Rajeev Nayan Priyadarshi Tanmoy Maji 

机构地区：[1]Department of Gastroenterology,All India Institute of Medical Sciences,Patna 801507,Bihar,India [2]Department of Pathology,All India Institute of Medical Sciences,Patna 801507,Bihar,India [3]Department of Surgical Gastroenterology,All India Institute of Medical Sciences,Patna 801507,Bihar,India [4]Department of Radiodiagnosis,All India Institute of Medical Sciences,Patna 801507,Bihar,India

出　　处：《World Journal of Hepatology》2023年第10期1140-1152,共13页世界肝病学杂志（英文版）（电子版）

摘　　要：BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.Therefore,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid mobilization.AIM To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with RA.METHODS This observational study included 155 consecutive cirrhosis patients with RA.The presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic dysfunctions.RESULTS A total of 69(44.5%)patients out of 155 had evidence of lymphatic dysfunction.Peripheral lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)patients.Compared to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein<5 g/dL)and lymphocytopenia(<15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without it.On multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P<0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrhosis patients with RA.Significant indicat

关 键 词：CIRRHOSIS LYMPHEDEMA Lymphangicetasia Refractory ascites Chylous ascites LYMPHOCYTOPENIA 

分 类 号：R575.2[医药卫生—消化系统]