肝硬化患者心功能改变及其与肝功能的关系

Cardiac function in patients with liver cirrhosis and its correlation with liver function

目的研究肝硬化患者的心脏结构和功能变化,探讨其与肝功能的关系。方法 35例肝硬化患者按照肝功能Child-Pugh分级,A级12例(A组),B级13例(B组),C级10例(C组)。20例健康体检者为对照组。利用超声心动图测量静息状态下左室射血分数(EF)、左室直径(Vd)、左房直径(LAs)、右室直径(RVd)、E/A比值、室间隔厚度(IVS)、左室后壁厚度(LVPW)、主动脉瓣环直径(AAO)等指标。结果肝硬化组LAs大于对照组(P=0.000),A组与B组间比较差异无统计学意义(P=0.248),A组与C组比较,A组LAs小于C组(P=0.039),B组与C组比较,B组LAs小于C组(P=0.008)。肝硬化组AAO大于对照组(P=0.000);IVS肝硬化组大于对照组(P=0.026);E/A值肝硬化组小于对照组(P=0.002)。结论肝硬化患者存在左心功能不全,以舒张功能不全为主,并与肝功能具有一定关系,提示肝硬化心肌病的存在。当肝硬化患者行心脏二维多普勒超声出现LAs增大、E/A<1时需注意肝硬化心肌病的可能。

Objective To investigate the cardiac structure and the function by echocardiography and their correlation with liver functon in cirrhotic patients.Methods A total of 35 cirrhotic patients and 20 healthy controls were enrolled in the study.Thirty-five cirrhotic patients were divided into group A,group B and group C（Child A group,Child B group and Child C group） according to the Child-Pugh score.Dimensional Doppler echocardiography was investigated and cardiac dimensions and left and right ventricular functions were evaluated.Results In liver cirrhosis group,LAs, IVS and AAO increased as compared with those of healthy group,whereas the value of E/A was reduced（P0.05, respectively）.There was no significant difference between the Child A,B and C group for IVS,AAO and the value of E/ A.Data of LAs in each group was compared,showing that Child AChild C and Child B Child C（P0.05, respectively）.Conclusion The cardiac systolic and diastolic function of patients with cirrhosis are deficient,and the degree of cardiac insufficiency is related to the damage of liver function.Our research confirmed the existence of cirrhotic cardiomyopathy.The possibility of cirrhotic cardiomyopathy should be considered if LAs increases and the E/A 1.