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Understanding fatigue in primary biliary cholangitis:From pathophysiology to treatment perspectives

World Journal of Hepatology 2022年第6期14卷 1111-1119页

作者： Erica Nicola Lynch Claudia Campani Tommaso Innocenti Gabriele Dragoni Maria Rosa Biagini Paolo Forte Andrea Galli Gastroenterology Research Unit Department of Experimental and Clinical Biomedical Sciences“Mario Serio”University of FlorenceFlorence 50134Italy Department of Experimental and Clinical Medicine University of FlorenceFlorence 50134Italy Department of Medical Biotechnologies University of SienaSiena 53100Italy Division of Gastroenterology University Hospital“Careggi”Florence 50134Italy

fatigue is considered one of the most frequent and debilitating symptoms in primary biliary cholangitis(PBC),affecting over 50%of PBC *** in five patients with PBC suffer from severe fatigue,which significantly impairs quality of *** is made up of a central and a peripheral component,whose pathophysiology is still greatly *** fatigue is characterised by a lack of self-motivation and can manifest both in physical and mental activities(lack of intention).peripheral fatigue includes neuromuscular dysfunction and muscle weakness(lack of ability).peripheral fatigue could be explained by an excessive deviation from aerobic to anaerobic metabolism leading to excessive lactic acid accumulation and therefore accelerated decline in muscle function and prolonged recovery *** opposed to itching,and with the exception of endstage liver disease,fatigue is not related to disease *** objective of this review is to outline current understanding regarding the pathophysiology of fatigue,the role of comorbidities and contributing factors,the main tools for fatigue assessment,the failed therapeutic options,and future treatment perspectives for this disabling *** fatigue is an extremely common and debilitating symptom and there is still no licensed therapy for fatigue in PBC patients,further research is warranted to understand its causative mechanisms and to find an effective treatment.

关键词： fatigue Primary biliary cholangitis Treatment Pathophysiology Central fatigue peripheral fatigue

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Muscle fatigue in women with primary biliary cirrhosis:Spectral analysis of surface electromyography

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World Journal of Gastroenterology 2006年第32期12卷 5186-5190页

作者： Maria Rosa Biagini Alessandro Tozzi Antonello Grippo Andrea Galli Stefano Milani Aldo Amantini Department of Clinical Pathophysiology Gastroenterology Unit University of FlorenceAOU CareggiFirenzeItaly Department of Neurological Science Neurophysiological Unit University of FlorenceAOU CareggiFirenzeItaly

AIM： To evaluate the myoelectric manifestations of peripheral fatigability in patients with primary biliary cirrhosis in comparison to healthy subjects. METHODS： Sixteen women with primary biliary cirrhosis without comorbidity and 13 healthy women matched for age and body mass index （BMI） completed the selfreported questionnaire fatigue impact scale. All subjects underwent surface electromyography assessment of peripheral fatigability. Anterior tibial muscle isometric voluntary contraction was executed for 20 s at 80% of maximal voluntary isometric contraction. During the exercise electromyographic signal series were recorded and root mean square （expression of central drive） as well as mean and median of electromyographic signal frequency spectrum （estimates of muscle fatigability） were com- puted. Each subject executed the trial two times. EMG parameters were normalized, then linear regression was applied and slopes were calculated. RESULTS： Seven patients were fatigued （median fatigue impact scale score： 38, range： 26-66） and 9 were not fatigued （median fatigue impact scale score： 7, range： 0-17）. The maximal voluntary isometric contraction was similar in patients （82, 54-115 N） and controls （87, 74-101 N）, and in patients with high （81, 54-115 N） and low fatigue impact scale scores （86, 65-106 N）. Root mean square as well as mean and median of frequency spectrum slopes were compared with the Mann-Whitney U test, and no significant difference was found between fatigued and non-fatigued patients and controls. CONCLUSION： No instrumental evidence of peripheral fatigability can be found in women with primary biliary cirrhosis but no comorbidity, suggesting that fatigue in such patients may be of central origin.

关键词： Primary biliary cirrhosis Cholestasis Surfaceelectromyography peripheral fatigue Muscle fatigue Fatigability Root mean square Mean frequency Medianfrequency fatigue impact scale

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