Association of lipid profile with decompensation, liver dysfunction, and mortality in patients with liver cirrhosis

Lipid metabolism is often disrupted in liver cirrhosis. The present study aimed to evaluate the impact of lipid profile on decompensation events, severity of liver dysfunction, and death in patients with liver cirrhosis. In a cross-sectional study, 778 patients with lipid profile data were enrolled, and then were divided into 240 and 538 patients with and without liver cirrhosis, respectively. In a cohort study, 314 cirrhotic patients with lipid profile data, who were prospectively followed, were enrolled. Lipid profile included total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), triglycerides (TG), and lipoprotein(a). In the cross-sectional study, cirrhotic patients with decompensation events had significantly lower levels of TC and lipoprotein(a) than those without; and cirrhotic patients with Child-Pugh class B and C had significantly lower levels of TC, HDL-c, LDL-c, and lipoprotein(a) than those with Child-Pugh class A. In the cohort study, there was an inverse association of survival with TC, HDL-c, and lipoprotein(a) levels; after adjusting for MELD score, TC (Hazard Ratio [HR] = 1.703, P = 0.034) and HDL-c (HR = 2.036, P = 0.005), but not lipoprotein(a) (HR = 1.377, P = 0.191), remained a significant predictor of death; when TC, HDL-c, lipoprotein(a), and MELD score were included in the multivariate Cox regression analysis, HDL-c (HR = 1.844, P = 0.024) was the only independent predictor of death. Decreased levels in specific components of lipid profile indicate more decompensation events, worse liver function, and reduced survival in liver cirrhosis. MELD score combined with HDL-c should be promising for the assessment of outcomes of cirrhotic patients.

肝硬化患者常存在脂质代谢紊乱。本研究旨在探讨脂质谱（lipid profile）对肝硬化患者失代偿事件、肝功能损害严重程度及死亡风险的影响。本横断面研究纳入778例具备脂质谱检测数据的患者，按是否合并肝硬化分为肝硬化组（240例）与非肝硬化组（538例）；另开展前瞻性队列研究，纳入314例具备脂质谱检测数据的肝硬化患者进行随访。本次研究涵盖的脂质谱指标包括总胆固醇（total cholesterol, TC）、高密度脂蛋白胆固醇（high-density lipoprotein-cholesterol, HDL-c）、低密度脂蛋白胆固醇（low-density lipoprotein-cholesterol, LDL-c）、甘油三酯（triglycerides, TG）及脂蛋白(a)（lipoprotein(a)）。横断面分析结果显示，合并失代偿事件的肝硬化患者，其总胆固醇与脂蛋白(a)水平显著低于无失代偿事件者；Child-Pugh分级为B、C级的肝硬化患者，其总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及脂蛋白(a)水平均显著低于Child-Pugh A级患者。队列研究结果显示，患者生存率与总胆固醇、高密度脂蛋白胆固醇及脂蛋白(a)水平呈负相关；校正终末期肝病模型（Model for End-Stage Liver Disease, MELD）评分后，总胆固醇（风险比（Hazard Ratio, HR）=1.703，P=0.034）与高密度脂蛋白胆固醇（HR=2.036，P=0.005）仍为死亡的显著预测因素，而脂蛋白(a)（HR=1.377，P=0.191）则无此关联；当将总胆固醇、高密度脂蛋白胆固醇、脂蛋白(a)及MELD评分纳入多因素Cox回归分析时，仅高密度脂蛋白胆固醇（HR=1.844，P=0.024）为死亡的独立预测因素。脂质谱特定组分的水平降低，提示肝硬化患者更易发生失代偿事件、肝功能损害更严重且生存率更低。将MELD评分与高密度脂蛋白胆固醇联合应用，有望用于肝硬化患者的预后评估。