心脏舒张功能不全对肝硬化门脉高压患者预后的影响

Effect of cardiac diastolic dysfunction on the prognosis of liver cirrhosis with portal hypertension

目的探讨心脏舒张功能不全对肝硬化门脉高压患者全临床事件发生的影响,分析心脏舒张功能不全与预后的相关性。方法收集2017年2月至2017年9月于我院消化科住院的肝硬化门脉高压症患者98例,其中Child-Pugh A级56例、B级37例、C级5例。行心电图和超声心动图(包括脉搏波多普勒和组织多普勒成像)检测。根据有无舒张功能不全分为两组进行随访,预期随访6~12个月,随访终点事件定义为全临床事件发生(死亡、再出血、肝衰竭、感染、肝肾综合征、肝性脑病、肝移植)。Kaplan-Meier曲线评估生存率,组间比较用Log-Rank检验。Cox比例风险回归分析全临床事件发生的影响因素。结果在98例患者中,58例(59. 2%)被诊断为左心室舒张功能不全,截至随访终点,3例(3. 1%)患者死亡,均发生在异常组,主要死因为肝功能衰竭。异常组与正常组全临床事件发生率、消化道再出血、累计未发生全临床事件率差异无统计学意义(P> 0. 05)。Cox比例风险回归分析得出HVPG(HR=1. 148,95%CI:1. 066~1. 237,P <0. 001)、心率(HR=1. 097,95%CI:1. 003~1. 201,P <0. 05)、NT-pro BNP (HR=1. 002,95%CI:1. 000~1. 003,P <0. 05)是影响全临床事件发生的独立危险因素。只将心血管相关指标代入,心率(HR=1. 055,95%CI:1. 004~1. 108,P <0. 05)、NT-pro BNP(HR=1. 001,95%CI:1. 000~1. 002,P <0. 05)是全临床事件发生的独立危险因素。结论心脏舒张功能不全并未显著增加与肝硬化患者预后相关的全临床事件发生。门脉压力、心率、NT-pro BNP是全临床事件发生的独立预测因素,应加强对这些指标的动态监测,早期干预可能改善预后。

Objective To investigate the influence of cardiac diastolic dysfunction on the occurrence of whole clinical events in liver cirrhosis with portal hypertension and to analyze the correlation of diastolic dysfunction with the prognosis. Methods Ninety-eight patients with liver cirrhosis-induced portal hypertension were collected from our hospital. According to the Child-Pugh scores, these subjects were categorized into class A （n = 56）, class B （n = 37） and class C （n = 5）. All patients received electrocardiogram and echocardiography （including pulse wave doppler and tissue doppler imaging）. These patients divided into two groups according to diastolic function were tollowed up 6 - 12 months as expected. The end point was defined as the occurrence of total clinical events （including death, rebleeding, liver failure, intection, hepatorenal syndrome, hepatic encephalopathy, liver transplantation）. Kaplan-Meier curve evaluated survival rate and Log-Rank test was used to compare survival rates between two groups. Cox proportional hazards model identified the factors linked to the whole clinical events. Results Fitiy-eight cases of 98 patients （59.2%） were diagnosed with let1 ventricular diastolic dysfunction （LVDD）. By the time of end point, 3 cases of deaths occurred in LVDD group died of liver failure. There were no statistically significant ditterences between two groups as respect to the occurrence of whole clinical events and recurrent digestive hemorrhage. HVPG （HR = 1. 148, 95% CI： 1. 066 - 1. 237, P 〈 0.001）, heart rate （HR=1.097, 95% CI： 1. 003 -1.201, P〈0.05）, NT-proBNP （HR=1.002, 95% CI： 1.000- 1. 003, P 〈 0.05 ） were the independent risk factors of whole clinical events based on the Cox proportional hazards model. When put relevant cardiovascular indicators in the model, the result remained the same as betore. Conclusion Diastolic dysfunction don＇ t significantly increase the occurrence of clinical events which are related to the prognosis of liver cirrhosis. Since portal vein pressure, heart rate, NT-proBNP are the independent predictors of overall clinical events, we should foucs on the dynamic monitoring of HVPG, HR, NT-proBNP. Early intervention can improve the prognosis.