心功能不全并发缺血性肝炎的临床特征与危险因素分析

Analysis of clinical features and risk factors of cardiac insufficiency complicated with ischemic hepatitis

目的分析心功能不全患者并发缺血性肝炎(IH)的生化特点及易发因素,为预防IH的发生提供理论支持。方法回顾性分析2010年1月1日至2018年11月30日聊城市人民医院收治的264例心功能衰竭患者,其中IH患者20例(IH组),分层随机抽样法选择同期无IH患者30例作为对照组,分析IH的临床特点及易发因素。结果IH组患者平均年龄为(73.5±2.4)岁,较对照组患者的平均年龄(65.5±2.9)岁年长(P<0.05);IH组患者上呼吸道感染、慢性支气管炎急性发作、心律失常等诱发因素占比高于对照组患者,且差异有统计学意义(P<0.05)。IH组患者病死率为35.0%(7/20),明显高于对照组患者的13.3%(4/30,P<0.05),死亡原因多为上呼吸道感染、慢性支气管炎急性发作、心律失常等诱发因素控制不良,心功能不全加重所致。谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)水平快速升高,超过正常值上限20倍以上,AST水平升高幅度大于ALT,10 d左右迅速恢复;而总胆红素、碱性磷酸酶、γ-谷氨酰转肽酶水平变化不明显。对年龄分层发现:≥70岁以上患者IH发生率高于<70岁患者,AST水平恢复正常的时间更长,且差异有统计学意义(P<0.05),提示高龄是发生IH的危险因素;对美国纽约心脏病协会(NYHA)心功能分级分层发现:NYHAⅢ+Ⅳ级患者IH发生率高于NYHAⅠ+Ⅱ级患者,AST水平恢复正常的时间更长,且差异有统计学意义(P<0.05);全心功能不全患者IH发生率高于左心衰竭患者,AST水平恢复正常的时间更长,且差异有统计学意义(P<0.05),提示心脏功能差是IH发生的危险因素。多元回归分析结果显示,NYHA心功能分级、诱发因素是IH发生的危险因素。结论诱发因素、心脏储备功能差是心脏功能不全患者伴发IH的危险因素。及时应用抗生素防治感染、纠正心律失常对于改善心功能不全并发IH患者的预后很重要。

Objective To analyze the biochemical characteristics and predisposing factors of ischemic hepatitis(IH)in patients with cardiac insufficiency,and to provide theoretical support for the prevention of IH.Methods A total of 364 patients with cardiac insufficiency admitted from January l,2010 to November 30,2018 in Liaocheng People’s Hospital were retrospectively analyzed.There were 20 patients with IH(IH group),and 30 patients without IH were selected as the control group by stratified random sampling to analyze the clinical characteristics and predisposing factors of IH.Results The mean age of patients in IH group was(73.5±2.4)years,which was older than that in the control group(65.5±2.9)years(P<0.05).The proportions of inducing factors such as upper respiratory tract infection,acute attack of chronic bronchitis and arrhythmia in the IH group were higher than those in the control group,with statistically significant differences(P<0.05).The mortality in the IH group was 35.0%(7/20),which was significantly higher than 13.3%(4/30)in the control group(P<0.05).The main causes of death were upper respiratory tract infection,acute attack of chronic bronchitis,arrhythmia and other inducing factors poorly controlled,and aggravation of cardiac insufficiency.The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and lactic dehydrogenase(LDH)increased rapidly,which was more than 20 times higher than the upper limit of normal value.The elevation of AST was higher than that of ALT,and recovered rapidly about 10 days later.The changes of total bilirubin,alkaline phosphates andγ-glutamyl transferase were not obvious.Age stratification showed that the incidence of IH in≥70 years old patients was higher than that in<70 years old patients,and AST level took longer to return to normal,and there were statistically significant differences(P<0.05),suggesting that advanced age was a risk factor for IH.According to the classification and stratification of heart function of New York Heart Association(NYHA),the incidence of IH in NYHAⅢ+Ⅳpatients was higher than that in NYHAⅠ+Ⅱpatients,and AST level took longer to return to normal,and there were statistically significant differences(P<0.05).The incidence of IH in patients with global cardiac insufficiency was higher than that in patients with left heart failure,and it took longer time for AST level to return to normal,and there were statistically significant differences(P<0.05),suggesting that poor cardiac function was a risk factor for IH.Multiple regression analysis showed that NYHA cardiac function grade and predisposing factors were the risk factors for IH.Conclusions Predisposing factors and poor cardiac reserve function are risk factors of IH in patients with cardiac insufficiency.Timely application of antibiotics to prevent infection and correct arrhythmia are very important to improve the prognosis of patients with cardiac insufficiency complicated with IH.