肝硬化患者左心功能变化与终末期肝病模型评分的相关性研究  

Changes of left ventricular function in cirrhotic patients and their correlation with the model for end-stage liver disease score

作　　者：李小鹏[1] 余珊珊[1] 李路[2] 韩东刚[1] 戴社教[2] 高亚[3] 

机构地区：[1]西安交通大学医学院第二附属医院超声研究室,陕西西安710004 [2]西安交通大学医学院第二附属医院消化科,陕西西安710004 [3]西安交通大学医学院第二附属医院小儿外科,陕西西安710004

出　　处：《南方医科大学学报》2015年第4期557-561,共5页Journal of Southern Medical University

基　　金：陕西省科技公关项目(2009K12-03;2013K12-20-29)

摘　　要：目的：研究肝硬化患者左心结构和功能的变化与终末期肝病模型（MELD）评分的关系。方法选择2012年6月-2014年6月期间89例肝硬化患者，根据MELD评分将其分为MELD≤9分、MELD10-19分和MELD≥20分3组，选择30例健康体检者为对照组。超声心动图测量静息状态下左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左房内径（LAD）、左室射血分数（LVEF）、心输出量（CO）、二尖瓣血流速度、E峰减速时间（DT）等指标，并评估其与MELD评分的关系。结果与对照组比较，肝硬化组LVESD、LVEDD、IVST、LAD增大，CO增加、VE/VA比值降低、DT延长，差异均具有统计学意义（P值〈0.05或0.01）。随MELD评分的增加，LVESD、LVEDD、IVST、LAD逐渐增大，DT延长，差异均具有统计学意义（P值〈0.05或0.01）；VE/VA比值在MELD10-19分组高于MELD≤9分组，在MELD≥20分组明显下降。分别有55%和44%患者出现左房增大和VE/VA≤1，MELD评分≥20分组中左房增大和VE/VA≤1患者的比例明显高于其他两组（P值均〈0.05）。LAD、LVEDD、DT与MELD评分呈正相关关系，r值分别为0.208、0.319和0.197，P值〈0.05或0.01。结论肝硬化患者可合并心脏受累，主要表现为左心舒张功能障碍，而且与肝病严重程度呈正相关。Objective To investigate the changes of left ventricular structure and function in patients with liver cirrhosis and their correlation with the model for end-stage liver disease （MELD） score. Methods A total of 89 cirrhotic patients admitted between June, 2012 and June, 2014 and 30 healthy control subjects were enrolled in the study. According to MELD score, the cirrhotic patients were divided into 3 groups with MELD scores≤9, between 10 and 19, and≥20. The parameters of the left ventricle in resting state were measured using Doppler echocardiography, including left ventricular end systolic diameter （LVESD）, left ventricular end diastolic diameter （LVEDD）, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left atrial diameter （LAD）, ejection fraction （LVEF）, cardiac output （CO）, mitral flow velocity, and E wave deceleration time （DT）, and evaluated their relationship with MELD score. Results Compared with the control subjects, the cirrhotic patients showed significantly increased LVESD, LVEDD, IVST, LAD, CO and DT but reduced VE/VA ratio （P〈0.05 or 0.01）. The values of LVESD, LVEDD, IVST, LAD and DT increased gradually with MELD scores （P〈0.05 or 0.01）. VE/VA ratio was higher in patients with MELD score of 10-19 than in those with MELD score≤9, and decreased significantly in those with MELD score≥20. Of the cirrhotic patients, 55%were found to have left atrial enlargement and 44%had a VE/VA ratio≤1;left atrial enlargement and a VE/VA ratio below 1 were more common in patients with a MELD score≥20 than in those with lower MELD scores. The LAD, LVEDD and DT were positively correlated with MELD scores （r=0.208, 0.319 and 0.197, respectively;P〈0.05 or 0.01）. Conclusion The patients with liver cirrhosis can have cardiac function deficiency manifested mainly by left ventricular diastolic dysfunction in positive correlation with the severity of liver disease.

关 键 词：肝硬化 心脏功能 左 超声心动图 肝硬化心肌病 

分 类 号：R575.2[医药卫生—消化系统]