急性心衰肝功能异常分析

Analysis of liver function abnormality in patients with acute heart failure

目的探讨急性心衰肝功能异常的患病率及其与预后的关系。方法回顾性分析我院2013年1月~2015年12月急性心衰住院患者156例,分析急性心衰肝功能异常的患病率、肝功能异常指标与急性心衰预后的关系。结果入院时肝功能异常总患病率为61%,其中46%的患者AST升高,31%的ALT升高,33%的胆红素升高,44%白蛋白降低,39%的患者肝功能正常。下列因素分别与肝功能异常独立相关：高HB和BNP与AST升高相关（P〈0.05）;高HB、TB、BNP与ALT升高独立相关（P〈0.05）;高HB、低钠、右室压升高与TB升高相关;BNP升高与白蛋白降低相关（P〈0.05）。血流动力学监测肝功能异常胆红素升高与右心房压力升高独立相关（P〈0.05）。Logistic分析示：低白蛋白和超过正常上限3倍的AST、ALT与患者死亡率独立相关。结论急性心衰肝功能异常较为常见,胆红素升高与异常的血流动力学改变独立相关。低白蛋白和超过正常上限3倍的AST、ALT与患者死亡率独立相关。

Objective To explore the relationship between the incidence of acute heart failure liver function abnormality and its prognosis. Methods Retrospective analysis of acute heart failure patients of 156 cases in our hospital from January 2013 to December 2015, the prevalence of liver dysfunction, the relationship between the above indexes and the prognosis of patients with acute heart failure were analyzed. Results On admission, the total prevalence of liver dysfunction reached 61%, of which 46% of patients with AST rised, 31% of ALT rised, 33% of bilirubin increased, 44%of albumin decreased, 39% of patients with normal liver function. The following factors were independently associated with abnormal liver function： high HB and BNP were correlation with the increase of AST（P〈0.05）; high TB, BNP, HB were independently associated with the increase of ALT（P〈0.05）; high HB, low sodium and right ventricular pressure associated with elevated TB, BNP increased and decreased（P〈0.05）. Hemodynamic monitoring of elevated liver function associated with elevated right atrial pressure independently（ P 0.05）. Logistic analysis showed that low albumin and the ALT, AST, which lower than 3 times of the normal limit, were independently associated with mortality. Conclusion The abnormal liver function of acute heart failure is more common, and the elevation of bilirubin is independent of the abnormal hemodynamic changes. Low albumin and more than 3 times the upper limit of the AST, ALT and patient mortality independently associated.