Naschitz J E, Slobodin G, Lewis R J, Zuckerman E, Yeshurun D
Department of Internal Medicine A, the Bnai Zion Medical Center, Haifa, Israel.
Am Heart J. 2000 Jul;140(1):111-20. doi: 10.1067/mhj.2000.107177.
The association of cardiac and liver disorders has not been extensively outlined in the literature.
A survey of the MEDLINE database was performed to assess the current status of research regarding the association between cardiac and liver disorders.
Combined cardiac and hepatic disorders occur in 3 different settings: heart diseases affecting the liver, liver diseases affecting the heart, and cardiac and hepatic disorders with joint etiology. The spectrum of heart diseases affecting the liver includes mild alterations of liver function tests in heart failure, cardiogenic ischemic hepatitis, congestive liver fibrosis, and cardiac cirrhosis. The liver diseases affecting the heart include complications of cirrhosis such as hepatopulmonary syndrome, portopulmonary hypertension, pericardial effusion, and cirrhotic cardiomyopathy as well as noncirrhotic cardiac disorders such as high-output failure caused by intrahepatic arteriovenous fistulae. Cardiac and hepatic disorders with joint etiology include infectious, metabolic, immune, vasculitic, and toxic disorders. We propose a practical approach to a diagnostic workup of combined cardiac and hepatic disorders based on recognizing the sequence of appearance of the cardiac and liver disease, presence of features of a multisystem disease, and presence of pathognomonic features. The evaluation of combined cardiac and hepatic disorders takes into consideration the expected benefit of treatment and the risks related to invasive procedures. Accordingly, investigations can be limited to ancillary tests for patients with congested liver and mild alterations of liver function tests, in cardiogenic ischemic hepatitis, patients with cardiac cirrhosis who are proposed for conservative treatment, and multisystem disease involving the heart and the liver. Conversely, comprehensive investigations are recommended when invasive therapeutic interventions are considered for the treatment of hepatopulmonary syndrome, portopulmonary hypertension, or arteriovenous fistulae.
Classification of a patient to any of the 3 categories-heart diseases affecting the liver, liver diseases affecting the heart, and cardiac and hepatic disorders with joint etiology-permits the physician to narrow the span of the possible diagnoses and allows for a more simple workup.
心脏和肝脏疾病之间的关联在文献中尚未得到广泛阐述。
对MEDLINE数据库进行了一项调查，以评估关于心脏和肝脏疾病之间关联的研究现状。
心脏和肝脏合并疾病出现在3种不同的情况中：影响肝脏的心脏病、影响心脏的肝脏疾病以及病因相同的心脏和肝脏疾病。影响肝脏的心脏病谱包括心力衰竭时肝功能检查的轻度改变、心源性缺血性肝炎、充血性肝纤维化和心源性肝硬化。影响心脏的肝脏疾病包括肝硬化的并发症，如肝肺综合征、门静脉肺动脉高压、心包积液和肝硬化性心肌病，以及非肝硬化性心脏疾病，如肝内动静脉瘘引起的高输出量心力衰竭。病因相同的心脏和肝脏疾病包括感染性、代谢性、免疫性、血管炎性和中毒性疾病。我们基于识别心脏和肝脏疾病出现的顺序、多系统疾病特征的存在以及特征性表现的存在，提出了一种针对心脏和肝脏合并疾病诊断检查的实用方法。对心脏和肝脏合并疾病的评估考虑了治疗的预期益处和与侵入性操作相关的风险。因此，对于肝脏充血且肝功能检查有轻度改变的患者、心源性缺血性肝炎患者、拟进行保守治疗的心源性肝硬化患者以及涉及心脏和肝脏的多系统疾病患者，检查可限于辅助检查。相反，当考虑对肝肺综合征、门静脉肺动脉高压或动静脉瘘进行侵入性治疗干预时，建议进行全面检查。
将患者分类为以下3类中的任何一类——影响肝脏的心脏病、影响心脏的肝脏疾病以及病因相同的心脏和肝脏疾病——可使医生缩小可能诊断的范围，并使检查更简单。
