肝功能异常水平对慢性心力衰竭患者的预测价值

Prognostic value of liver function abnormalities in patients with chronic heart failure

目的探讨慢性心力衰竭(chronic heart failure,CHF)患者肝功能损害水平与CHF严重程度之间的关系。方法87例CHF住院患者根据纽约心功能分级分为心功能Ⅱ级23例,心功能Ⅲ～Ⅳ级64例。CHF患者入院第2天行肝功能、脑钠肽(brain natriuretic peptide,BNP)及超声心动图检查。同期,选取30例排除心力衰竭的门诊体检者行肝功能及超声心动图检查。结果CHF组血清丙氨酸氨基转移酶(Alt)、天门冬氨酸氨基转移酶(Ast)和总胆红素均显著高于对照组,差异有统计学意义(P<0.05)。心功能Ⅲ～Ⅳ级组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素和BNP均显著高于心功能Ⅱ级组,差异有统计学意义(P<0.05)。CHF组白蛋白和左心室射血分数低于对照组,心功能Ⅲ～Ⅳ级组白蛋白和左心室射血分数低于心功能Ⅱ级组,差异均有统计学意义(P<0.05)。心功能Ⅲ～Ⅳ级组直接胆红素水平高于对照组,差异有统计学意义(P<0.05)。CHF组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、直接胆红素与BNP成正相关(r1=0.37,r2=0.434,r3=0.49,r4=0.406,P<0.01);丙氨酸氨基转移酶、总胆红素和BNP与左心室射血分数成负相关(r1=-0.303,r2=-0.426,r3=-0.455,P<0.01)。结论CHF患者常出现肝功能及BNP水平改变,其水平高低对于判断心力衰竭的严重程度有一定的预测意义。

Objective To investigate the relationship between liver function abnormalities and the severity of heart failure in patients with chronic heart failure （CHF）. Methods Totally 87 patients with CHF classified as cardiac functional class II -IV according to New York Heart Association functional classification （23 cases with class II and 64 cases with class III -IV ） were investigated. Ultrasonic cardiogram （UCG）, liver function and serum level of brain natriuretic peptide （BNP） were detected the day after admission. UCG and liver function were also examined in 30 cases without CHF （controls）. Results Alanine transaminase （Alt）, aspartate transaminase （Ast） and total bilirubin （Tbil） levels were significantly increased in patients with CHF as compared with those in the controls （P〈0.05）. Ah, Ast, Tbil and BNP levels in patients with class III-IV were obviously higher than those in patients with class II （P〈 0.05 ）. Serum level of albumin （Alb） and left ventricular ejection fraction（LVEF） in patients with CHF were lower than those in controls, and those in patients with class Ill-iV were lower than those in patients with class II （P〈0.05）. Serum level of direct bilirubin （Dbil） in patients with class HI-IV was higher than that in controls （P〈0.05）. Levels of Alt, Ast and Tbil were positively correlated with serum BNP levels （r1=0.37, r2=0.434, r3=0.49, r4=0.406, P〈0.O1 ） in patients with CHF. Moreover, levels of Ah, Tbil and BNP were negatively correlated with LVEF （r1=-0.303 ,r2=- 0.426, r3=-0.455, P〈0.01 ）. Conclusion Liver function abnormalities and BNP change are common in patients with CHF. Liver function abnormalities and BNP levels may be useful for predicting the severity of heart failure in patients with CHF.