[Autonomic nervous activity in patients with chronic liver disease especially liver cirrhosis]

Fifty three patients with liver cirrhosis and other chronic liver disease were divided into three different groups according to severity (group I: non-cirrhotic group, group II: compensated cirrhotic group, group III: decompensated cirrhotic group) and were studied with regard to their autonomic nervous and general nervous activity. To estimate the patients' autonomic nervous activity, they were examined on the following items: 1) their subjective symptoms, 2) orthostatic dysregulation, 3) coefficient of variation in R-R interval in ECG (CVR-R) at rest, 4) minimum heart rate (MHR) at night, CVR-R at MHR at night, disparity in MHR between day and night (all three of these items measured using the Holter ECG), 5) serum adrenalin, noradrenaline, cyclic AMP, and cyclic GMP. Meanwhile, general nervous activity was evaluated by measuring the reaction time to sound and light stimuli and by performing a number connection test. Cardiac function was also measured using radionuclide angiography to study its relationship to autonomic nervous disturbance in patients with chronic liver disease. The results of autonomic nervous function tests, especially CVR-R at rest, MHR at night, CVR-R at MHR at night and the disparity in MHR between day and night, indicated a marked lowering of autonomic nervous function in group III. In the serological examination, serum noradrenaline. and cyclic GMP levels were significantly higher in groups II and III. The evaluation of general nervous function showed that the reaction time to sound and light stimuli was significantly slower in group III than in group I. The cardiac function test revealed no statistically significant differences between the groups. In conclusion, autonomic nervous disturbance in patients with chronic liver disease seems to increase gradually as the disease progresses and to emerge as a distinct clinical symptom chiefly at the decompensated stage of liver cirrhosis.