Ocel Joseph J, Edwards William D, Tazelaar Henry D, Petrovic Lydia M, Edwards Brooks S, Kamath Patrick S
Mayo Medical School, Division of Anatomic Pathology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2004 Apr;79(4):492-501. doi: 10.4065/79.4.492.
To determine underlying conditions in patients undergoing both heart and liver biopsies.
Our study group consisted of 32 patients at the Mayo Clinic in Rochester, Minn, who underwent both endomyocardial and nonsurgical liver biopsies and who underwent at least one of these procedures between January 1,1981, and December 31,2000. Patients were categorized as having (1) heart disease affecting the liver, (2) liver disease affecting the heart, (3) the same disease affecting both organs, or (4) different diseases affecting each organ independently.
Among 32 patients, cardiac dysfunction was present in 28 (19 systolic, 9 diastolic), and hepatic dysfunction was present in 31. In group 1, 3 of 4 patients had cardiac amyloidosis with secondary hepatic congestion. In group 2, all 3 patients had cirrhosis with cirrhotic cardiomyopathy. Group 3 included 5 patients with hemochromatosis, 3 with alcoholism, and 1 with amyloidosis. In group 4, 8 of 16 patients had idiopathic cardiomyopathy, and 8 had hepatitis. Overall, of 8 patients with hemochromatosis, 3 without cardiac iron had improved cardiac function after phlebotomy, and 1 with cardiac iron had no cardiac dysfunction. Among 7 patients with alcoholism, 3 had alcoholic liver and heart disease. Of 5 patients with cardiac amyloidosis, 1 had hepatic amyloid. Ten patients underwent transplantation (6 liver, 3 heart, and 1 heart and liver).
In one half of the patients in the study group, heart and liver diseases had independent causes. In patients with hemochromatosis, there was little correlation between cardiac iron and systolic dysfunction. In patients with chronic alcoholism, liver and heart disorders often had nonalcoholic causes. With cardiac amyloidosis, hepatic dysfunction was generally due to congestion. Specific disease in one organ did not necessarily imply similar involvement in the other. Thus, heart or liver biopsy may be useful in patients being evaluated for liver or heart transplantation, respectively.
确定接受心脏和肝脏活检患者的潜在病情。
我们的研究组由明尼苏达州罗切斯特市梅奥诊所的32例患者组成，这些患者接受了心内膜心肌活检和非手术肝脏活检，且在1981年1月1日至2000年12月31日期间至少接受了其中一项检查。患者被分为以下几类：（1）影响肝脏的心脏病；（2）影响心脏的肝脏病；（3）影响两个器官的同一种疾病；（4）分别独立影响每个器官的不同疾病。
32例患者中，28例存在心脏功能障碍（19例为收缩功能障碍，9例为舒张功能障碍），31例存在肝功能障碍。在第1组中，4例患者中有3例患有心脏淀粉样变性并伴有继发性肝淤血。在第2组中，所有3例患者均患有肝硬化并伴有肝硬化性心肌病。第3组包括5例血色素沉着症患者、3例酒精中毒患者和1例淀粉样变性患者。在第4组中，16例患者中有8例患有特发性心肌病，8例患有肝炎。总体而言，8例血色素沉着症患者中，3例无心脏铁沉积的患者在放血后心脏功能有所改善，1例有心脏铁沉积的患者无心脏功能障碍。7例酒精中毒患者中，3例患有酒精性肝病和心脏病。5例心脏淀粉样变性患者中，1例患有肝脏淀粉样变性。10例患者接受了移植手术（6例肝脏移植、3例心脏移植和1例心脏及肝脏移植）。
研究组中有一半患者的心脏和肝脏疾病有独立病因。在血色素沉着症患者中，心脏铁沉积与收缩功能障碍之间几乎没有相关性。在慢性酒精中毒患者中，肝脏和心脏疾病往往有非酒精性病因。对于心脏淀粉样变性，肝功能障碍通常是由于淤血所致。一个器官的特定疾病不一定意味着另一个器官也有类似病变。因此，心脏或肝脏活检可能分别对接受肝移植或心脏移植评估的患者有用。
