肝硬化患者心功能改变与终末期肝病模型评分的相关性研究

Correlation between heart function changes and score of model for end-stage liver disease in patients with liver cirrhosis

摘要:

目的  研究肝硬化患者心功能的改变，探讨其与终末期肝病模型（MELD）评分的相关性。方法  应用心脏彩超检测反映心脏收缩、舒张功能的指标，将不同终末期肝病模型MELD评分的心功能进行比较，分析其相关性。结果  肝硬化患者心功能与MELD评分的关系：MELD≤9分患者的左室射血分数（LVEF）为（58.12±0.18）%，二尖瓣舒张早期流速峰值（E）/二尖瓣舒张晚期流速峰值（A）值为（1.04±0.03），左房直径（Las）为（30.48±0.36）mm；MELD 10～19分患者的LVEF为（60.58±1.21）%，E/A值为（0.78±0.03），LAs为（27.14±0.56）mm；MELD≥20分患者的LVEF为（56.71±0.54）%，E/A值（0.53±0.01），LAs为（34.12±0.72）mm。MELD评分3者间两两比较显示，①MELD≤9分、10～19分肝硬化患者的LVEF值均高于MELD≥20分患者，MELD≤9分患者的LVEF值与MELD 10～19分患者比较、MELD 10～19分患者的LVEF值与MELD≥20分患者比较，差异有统计学意义（P <0.05）。②E/A值随MELD评分逐步降低，MELD评分3者间两两比较差异有统计学意义（P <0.05），Spearman相关性检验显示，E/A值与MELD评分呈负相关，相关系数为-0.935，P <0.05；MELD≥20分肝硬化患者的LAs高于MELD≤9分、10～19分患者，不同MELD评分肝硬化患者的Las比较，差异有统计学意义（P <0.05）。结论  肝硬化患者可出现心功能受损，其程度随肝功能的恶化而加重。

Abstract:

Objective To study the changes of cardiac function in patients with liver cirrhosis and their relationship with the score of model for end-stage liver disease (MELD). Methods Cardiac systolic and diastolic functions were detected by echocardiography, and the correlation between MELD score and end-stage liver disease model was analyzed. Results The relationships between MELD score and cardiac functions in patients with liver cirrhosis were as follows: in the patients with MELD score ≤ 9, LVEF was (58.12 ± 0.18)%, E/A was (1.04 ± 0.03), LAs was (30.48 ± 0.36) mm; in the patients with MELD score of 10-19, LVEF was (60.58 ± 1.21)%, E/A was (0.78 ± 0.03), LAs was (27.14 ± 0.56) mm; in the patients with MELD score ≥20, LVEF was (56.71 ± 0.54)%, E/A was (0.53 ± 0.01), LAs was (34.12 ± 0.72) mm. LVEF values in the patients with MELD score ≤ 9 and MELD score of 10-19 were higher than that in the patients with MELD score ≥ 20; the LVEF value in the patients with MELD score of 10-19 was significantly different from those in the patients with MELD score ≤9 and MELD score ≥ 20 (P < 0.05). The E/A value decreased gradually with the increasing of MELD scores, there were significant differences among the three groups with different MELD scores (P < 0.05). Spearman correlation test showed that E/A was negatively correlated with the MELD score, the correlation coefficient was -0.935 (P < 0.05); LAs in the patients with MELD score ≥20 was higher than that in the patients with MELD score ≤ 9 and MELD score of 10-19 with significant differences among the three groups with different MELD scores (P < 0.05). Conclusions In patients with liver cirrhosis, heart function is impaired, which is aggravated with the deterioration of liver function.