[1]买吾拉江·马木提,苏比努尔·吐尔孙.慢性心力衰竭患者合并肝功能损伤的临床特征及危险因素分析[J].医学信息,2023,36(06):124-127.[doi:10.3969/j.issn.1006-1959.2023.06.027]
　Maiwulajiang·Mamuti,Subinuer·Tuersun.Clinical Characteristics and Risk Factors of Chronic Heart Failure Patients with Liver Function Injury[J].Journal of Medical Information,2023,36(06):124-127.[doi:10.3969/j.issn.1006-1959.2023.06.027]
点击复制

慢性心力衰竭患者合并肝功能损伤的临床特征及危险因素分析()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年06期
页码:
124-127
栏目:
论著
出版日期:
2023-03-15

文章信息/Info

Title:
Clinical Characteristics and Risk Factors of Chronic Heart Failure Patients with Liver Function Injury
文章编号:
1006-1959（2023）06-0124-04
作者:
买吾拉江·马木提; 苏比努尔·吐尔孙
（喀什地区第一人民医院心脏病重症监护，新疆 喀什 844000）
Author(s):
Maiwulajiang·Mamuti; Subinuer·Tuersun
(Department of Cardiac Intensive Care Unit,the First People’s Hospital of Kashi Prefecture,Kashi 844000,Xinjiang,China)
关键词:
慢性心力衰竭; 肝功能损伤; 丙氨酸氨基转移酶; 心功能分级
Keywords:
Chronic heart failure; Liver function injury; Alanine aminotransferase; Cardiac function classification
分类号:
R541.6
DOI:
10.3969/j.issn.1006-1959.2023.06.027
文献标志码:
A
摘要:
目的 研究慢性心力衰竭患者合并肝功能损伤的临床特征及危险因素。方法 回顾分析2021年1月-2022年12月在我院诊治的87例慢性心力衰竭合并肝功能损伤患者临床资料，比较不同心功能分级患者肝功能损伤阳性检出率和肝功能指标[丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、白蛋白、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）]水平，不同肝功分级患者肝功能指标水平以及心功能指标[左心室舒张末期内径（LVEDD）、左心房内径（LAD）、右心室舒张末期内径（RVEDD）、右房横径（RATD）、肺动脉收缩压（PASP）、左心室射血分数（LVEF）]，采用单因素和多因素 Logistic 回归分析慢性心力衰竭患者合并肝功能损伤的危险因素。结果 Ⅳ级心功能患者ALT、AST、TBIL、GGT、ALP水平均高于Ⅰ级、Ⅱ级、Ⅲ级患者，且Ⅲ级高于Ⅰ级、Ⅱ级，Ⅱ级高于Ⅰ级（P＜0.05）；Ⅳ级心功能患者白蛋白低于Ⅰ级、Ⅱ级、Ⅲ级患者，且Ⅲ级低于Ⅰ级、Ⅱ级，Ⅱ级低于Ⅰ级（P＜0.05）；不同肝功分级（5~6、7~9、＞10分）患者年龄、性别、病程、合并症、心功能分级比较，差异无统计学意义（P＞0.05）；5~6分患者ALT、AST水平与7~9、＞10分患者比较，差异无统计学意义（P＞0.05）；5~6分患者GGT、ALP均小于7~9、＞10分患者，且7~9分患者小于＞10分患者（P＜0.05）；5~6分患者LVEF高于7~9、＞10分患者，且7~9分患者高于＞10分患者（P＜0.05）；5~6分患者LVEDD、LAD、RVEDD、RATD、PASP均低于7~9、＞10分患者，且7~9分患者小于＞10分患者（P＜0.05）；多因素 Logistic 回归分析显示，RVEDD、RATD、LVEDD、PASP是慢性心力衰竭患者合并肝功能损伤的独立危险因素。结论 慢性心力衰竭患者合并肝功能损伤患者，会随着心功能分级升高而加重，且ALT、AST可判断慢性心力衰竭合并肝功能损伤程度。随着肝功能损伤分级加重，LVEF降低，LVEDD、LAD、RVEDD、RATD、PASP均升高， RVEDD、RATD、LVEDD、PASP是慢性心力衰竭患者合并肝功能损伤的危险因素。
Abstract:
Objective To study the clinical characteristics and risk factors of chronic heart failure (CHF) patients with liver function injury.Methods Retrospective analysis of the clinical data of 87 patients with chronic heart failure complicated with liver function injury diagnosed and treated in our hospital from January 2021 to December 2022. The positive detection rate of liver function injury and the levels of liver function indexes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin, γ-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP)] in patients with different cardiac function grades were compared. The levels of liver function indexes and cardiac function indexes [left ventricular end-diastolic diameter (LVEDD), left atrial diameter (LAD), right ventricular end-diastolic diameter (RVEDD), right atrial transverse diameter (RATD), pulmonary artery systolic pressure (PASP), left ventricular ejection fraction (LVEF)] in patients with different liver function grades were analyzed. The risk factors of liver function injury in patients with chronic heart failure were analyzed by univariate and multivariate logistic regression.Results The levels of ALT, AST, TBIL, GGT and ALP in patients with grade Ⅳ cardiac function were higher than those in patients with grades Ⅰ, Ⅱ and Ⅲ, and those of grade Ⅲ were higher than those of grades Ⅰ and Ⅱ, and those of grade Ⅱ were higher than those of grade Ⅰ (P<0.05). The albumin of patients with grade Ⅳ cardiac function was lower than that of patients with grade Ⅰ, grade Ⅱ and grade Ⅲ, and that of grade Ⅲ was lower than that of grade Ⅰ and grade Ⅱ, and that of grade Ⅱ was lower than that of grade Ⅰ (P<0.05). There was no significant difference in age, gender, course of disease, complications and cardiac function grading among patients with different liver function grading (5-6 scores, 7-9 scores, >10 scores) (P>0.05). There was no significant difference in ALT and AST levels between patients with 5-6 scores and patients with 7-9 scores and >10 scores (P>0.05). GGT and ALP in patients with 5-6 scores were less than those in patients with 7-9 scores and > 10 scores, and patients with 7-9 scores were less than patients with >10 scores (P<0.05). The LVEF of patients with 5-6 points was higher than that of patients with 7-9 scores and >10 scores, and that of patients with 7-9 scores was higher than that of patients with >10 scores (P<0.05). LVEDD, LAD, RVEDD, RATD and PASP in patients with 5-6 scores were lower than those in patients with 7-9 scores and >10 scores, and those in patients with 7-9 scores were less than those in patients with > 10 scores (P<0.05). Multivariate Logistic regression analysis showed that RVEDD, RATD, LVEDD and PASP were independent risk factors for liver function injury in patients with chronic heart failure.Conclusion Patients with chronic heart failure complicated with liver function injury will aggravate with the increase of cardiac function classification, and ALT and AST can judge the degree of chronic heart failure complicated with liver function injury. With the aggravation of liver function injury, LVEF decreased, LVEDD, LAD, RVEDD, RATD and PASP increased. Therefore, RVEDD, RATD, LVEDD and PASP are risk factors for liver function injury in patients with chronic heart failure.

参考文献/References:

[1]Okada A,Sugano Y,Nagai T,et al.Usefulness of the direct and/or total bilirubin to predict adverse outcomes in patients with acute decompensated heart failure[J].Am J Cardiol,2017,119(12):2035-2041.[2]朱小山,马可忠,周汉云,等.冻干重组人脑利钠肽与富马酸比索洛尔对缺血性心肌病室性心律失常并急性心力衰竭患者血管内皮功能和血清炎性因子水平影响的对比研究[J].实用心脑肺血管病杂志,2018,26(7):60-64.[3]Huang S,Wei Q,Zhi X,et al.Application value of serum s ST2 in diagnosis and prognosis of heart failure[J].Chinese Journal of Biotechnology,2020,36(9):1713-1722. [4]张琦,张荣成,姚佑楠,等.肝脏纤维化程度评分在住院心力衰竭患者风险评估中的应用[J].中国循环杂志,2019,34(8):796-802.[5]中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南,2018[J].中华心血管病杂志,2018,46(10):760-789.[6]Goncalvesova E,Kovacova M.Heart failure affects liver morphologyand function.What are the clinical implications[J].Bratisl Lek Listy,2018,119(2):98-102.[7]柳森,王莉,刘旭,等.肝脏功能和生化指标对心力衰竭程度及预后的预测价值[J].心血管病学进展,2017,36(2):227-230.[8]Feng D,Wang M,Hu J,et al.Prognostic value of the albumin-bilirubin grade in patients with hepatocellular carcinoma and other liver diseases[J].Ann Transl Med,2020,8(8):553. [9]何倩.血清NT-Pro-BNP与肝功能对评估慢性心力衰竭患者病情的作用[D].衡阳:南华大学,2019.[10]郑刚.肝功能异常对心力衰竭患者临床预后的判断价值[J].中国心血管杂志,2017,25(2):125-128.[11]吴丹.不同类型心力衰竭患者胆红素水平与超声心动图参数的相关性[D].石家庄:河北医科大学,2018.[12]Mene-Afejuku TO,Moisa EA,Akinlonu A,et al.The relevance of serum albumin among elderly patients with acute decompensated heart failure[J].J Geriatr Cardiol,2019,16(7):522-528.[13]申岩,高瑞敏,康玲玲,等.不同程度CHF患者血浆BNP、和肽素水平变化及其与心功能分级的相关性[J].心血管康复医学杂志,2019,28(5):583-586.[14]韩晶晶.慢性心力衰竭并发肝功能损害的临床特点分析[J].解放军预防医学杂志,2017,12(6):145-148.[15]张颖,向晋涛,张仲道,等.慢性心力衰竭患者的长程心电图大数据散点图特征观察及分析[J].中国心脏起搏与心电生理杂志,2018,32(1):41-48.[16]方家雄,余鹏,余惠春,等.老年人心力衰竭与肝、肾功能及血脂变化的相关性[J].武警物流大学学报,2017,25(9):709-713.[17]Correale M,Tarantino N,Petrucci R,et al.Liver disease and heart failure: Back and forth[J].Eur J Intern Med,2018,48:25-34.[18]孔凡良,吴同国.心源性肝损伤对心力衰竭的影响[J].中华心律失常学杂志,2017,29(1):123-126.

相似文献/References:

[1]贺明清,刘孝娅.环磷腺苷葡胺治疗慢性心力衰竭临床疗效观察[J].医学信息,2018,31(10):135.[doi:10.3969/j.issn.1006-1959.2018.10.045]
　HE Ming-qing,LIU Xiao-ya.Clinical Efficacy of Cyclic Adenosine Glucosamine in the Treatment of Chronic Heart Failure[J].Journal of Medical Information,2018,31(06):135.[doi:10.3969/j.issn.1006-1959.2018.10.045]
[2]李祥敏.多普勒彩超在慢性心力衰竭患者中的诊断特点分析[J].医学信息,2022,35(11):144.[doi:10.3969/j.issn.1006-1959.2022.11.038]
　LI Xiang-min.Analysis of Diagnostic Characteristics of Doppler Ultrasound in Patients with Chronic Heart Failure[J].Journal of Medical Information,2022,35(06):144.[doi:10.3969/j.issn.1006-1959.2022.11.038]
[3]付 敏.基于医院的延续性护理对慢性心力衰竭患者自我护理能力及生活质量的影响[J].医学信息,2022,35(11):187.[doi:10.3969/j.issn.1006-1959.2022.11.050]
　FU Min.Effect of Hospital-based Continuous Nursing on Self-care Ability and Quality of Life in Patients with Chronic Heart Failure[J].Journal of Medical Information,2022,35(06):187.[doi:10.3969/j.issn.1006-1959.2022.11.050]
[4]李鹏飞,何荣华,王琼涛,等.单胺氧化酶对老年心力衰竭患者临床应用价值[J].医学信息,2018,31(17):78.[doi:10.3969/j.issn.1006-1959.2018.17.023]
　LI Peng-fei,HE Rong-hua,WANG Qiong-tao,et al.Clinical Value of Monoamine Oxidase in Elderly Patients with Heart Failure[J].Journal of Medical Information,2018,31(06):78.[doi:10.3969/j.issn.1006-1959.2018.17.023]
[5]曹 云,李树茂,裘 冬,等.益气温阳中药治疗慢性舒张性心力衰竭的疗效观察[J].医学信息,2019,32(01):162.[doi:10.3969/j.issn.1006-1959.2019.01.051]
　CAO Yun,LI Shu-mao,QIU Dong,et al.Therapeutic Effect of Yiqiwenyang Chinese Medicine on Chronic Diastolic Heart Failure[J].Journal of Medical Information,2019,32(06):162.[doi:10.3969/j.issn.1006-1959.2019.01.051]
[6]李 月,胡 雅,曹春乐,等.慢性心力衰竭患者健康心理控制源与自我管理的相关性研究[J].医学信息,2019,32(05):133.[doi:10.3969/j.issn.1006-1959.2019.05.042]
　LI Yue,HU Ya,CAO Chun-le,et al.Correlation between Health Psychological Control Sources and Self-management in Patients with Chronic Heart Failure[J].Journal of Medical Information,2019,32(06):133.[doi:10.3969/j.issn.1006-1959.2019.05.042]
[7]韩婷婷,王 虹,吴美美,等.N-proBNP对慢性心衰患者发生肺动脉高压的预测价值[J].医学信息,2019,32(05):114.[doi:10.3969/j.issn.1006-1959.2019.05.035]
　HAN Ting-ting,WANG Hong,WU Mei-mei,et al.Predictive Value of N-proBNP for Pulmonary Hypertension in Patients with Chronic Heart Failure[J].Journal of Medical Information,2019,32(06):114.[doi:10.3969/j.issn.1006-1959.2019.05.035]
[8]张文波,杨玉雯.希氏束起搏在慢性心力衰竭患者中的应用[J].医学信息,2019,32(10):41.[doi:10.3969/j.issn.1006-1959.2019.10.015]
　ZHANG Wen-bo,YANG Yu-wen.Application of His Bundle Pacing in Patients with Chronic Heart Failure[J].Journal of Medical Information,2019,32(06):41.[doi:10.3969/j.issn.1006-1959.2019.10.015]
[9]张凤娜,高伟勤.6min步行试验训练对慢性心力衰竭患者心功能的影响[J].医学信息,2019,32(16):97.[doi:10.3969/j.issn.1006-1959.2019.16.030]
　ZHANG Feng-na,GAO Wei-qin.The Effect of 6min Walking Test Training on Cardiac Function in Patients with Chronic Heart Failure[J].Journal of Medical Information,2019,32(06):97.[doi:10.3969/j.issn.1006-1959.2019.16.030]
[10]单玉梅.尼可地尔联合单硝酸异山梨酯治疗冠心病慢性心力衰竭的疗效[J].医学信息,2021,34(21):153.[doi:10.3969/j.issn.1006-1959.2021.21.043]
　SHAN Yu-mei.Effect of Nicorandil Combined with Isosorbide Mononitrate in the Treatment of Coronary Heart Disease with Chronic Heart Failure[J].Journal of Medical Information,2021,34(06):153.[doi:10.3969/j.issn.1006-1959.2021.21.043]

更新日期/Last Update: 1900-01-01