Dichtl Wolfgang, Vogel Wolfgang, Dunst Karin M, Grander Wilhelm, Alber Hannes F, Frick Matthias, Antretter Herwig, Laufer Günther, Pachinger Otmar, Pölzl Gerhard
Clinical Division of Cardiology, Innsbruck Medical University, Innsbruck, Austria.
Transpl Int. 2005 Jun;18(6):697-702. doi: 10.1111/j.1432-2277.2005.00122.x.
Chronic cardiac hepatopathy is a common entity in patients evaluated for heart transplantation (HTX). Hepatic injury is caused by severe heart failure resulting from prolonged recurrent congestion and/or impaired arterial perfusion. No data are available on the reversibility of cardiac hepatopathy in patients undergoing HTX. Data of 56 consecutive adult patients undergoing HTX during 2000-02 at the University Hospital of Innsbruck were analysed retrospectively. The following parameters were evaluated at the time of listing and 3, 6 and 12 months after HTX. Plasma levels of gamma-glutamyl transferase (gamma-GT), alkaline phosphatase (AP), bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and total plasma protein. When listed for HTX, only 12% of all patients analysed had physiological values throughout the seven laboratory parameters assessed. Elevated levels of gamma-GT, AP, bilirubin, AST, ALT, LDH and total plasma protein were detected in 66.6%, 29%, 50%, 16.7%, 10%, 40% and 18% of all patients respectively. Accordingly, median plasma levels of gamma-GT, bilirubin and LDH were elevated, whereas the mean plasma level of AP was at the upper normal range. In contrast, median plasma level of AST and mean plasma levels of ALT and total plasma protein were within the normal range: gamma-GT (median, 109.0; range, 634.0 U/l; n = 36), AP (mean, 120.2 +/- 78.9 U/l; n = 29), bilirubin (median, 1.3; range, 16.1 mg/dl; n = 32), LDH (median, 226.0; range, 2355.0 U/l; n = 33), AST (median, 29.0; range, 145.0 U/l; n = 36), ALT (mean, 28.3 +/- 20.8 U/l; n = 36) and total plasma protein (mean, 7.2 +/- 1.1 g/dl; n = 25). Within 3 months after HTX, elevated parameters except LDH significantly ameliorated: gamma-GT (median, 59.0; range, 1160.0 U/l; P = 0.011), AP (92.2 +/- 75.2 U/l; P = 0.016), bilirubin (median, 0.9; range, 8.1 mg/dl; P = 0.004), LDH slightly increased (median, 281.0; range, 543.0 U/l; P = 0.039), but there was a delayed improvement of this parameter after 6 and 12 months post-HTX. End-stage heart failure is characterized by a cholestatic liver enzyme profile with elevated plasma levels of gamma-GT and bilirubin. These parameters significantly improve within 3 months after HTX. Therefore, chronic cardiac hepatopathy seems to be a benign, potentially reversible disease.
慢性心性肝病在接受心脏移植（HTX）评估的患者中是一种常见病症。肝损伤由长期反复充血和/或动脉灌注受损导致的严重心力衰竭引起。目前尚无关于接受HTX患者心性肝病可逆性的数据。对2000年至2002年期间在因斯布鲁克大学医院连续接受HTX的56例成年患者的数据进行了回顾性分析。在列入移植名单时以及HTX后3、6和12个月评估了以下参数。血浆γ-谷氨酰转移酶（γ-GT）、碱性磷酸酶（AP）、胆红素、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、乳酸脱氢酶（LDH）和总血浆蛋白水平。在列入HTX名单时，在所有分析的患者中，只有12%在评估的七个实验室参数中均具有生理值。在所有患者中，分别有66.6%、29%、50%、16.7%、10%、40%和18%检测到γ-GT、AP、胆红素、AST、ALT、LDH和总血浆蛋白水平升高。相应地，γ-GT、胆红素和LDH的血浆中位数水平升高，而AP的血浆平均水平处于正常上限范围。相比之下，AST的血浆中位数水平以及ALT和总血浆蛋白的血浆平均水平在正常范围内：γ-GT（中位数，109.0；范围，634.0 U/l；n = 36），AP（平均，120.2±78.9 U/l；n = 29），胆红素（中位数，1.3；范围，16.1 mg/dl；n = 32），LDH（中位数，226.0；范围，2355.0 U/l；n = 33），AST（中位数，29.0；范围，145.0 U/l；n = 36），ALT（平均，28.3±20.8 U/l；n = 36）和总血浆蛋白（平均，7.2±1.1 g/dl；n = 25）。在HTX后3个月内，除LDH外的升高参数显著改善：γ-GT（中位数，59.0；范围，1160.0 U/l；P = 0.011），AP（92.2±75.2 U/l；P = 0.016），胆红素（中位数，0.9；范围，8. mg/dl；P = 0.004），LDH略有升高（中位数，281.0；范围，543.0 U/l；P = 0.039），但该参数在HTX后6个月和12个月有延迟改善情况。终末期心力衰竭的特征是胆汁淤积性肝酶谱，血浆γ-GT和胆红素水平升高。这些参数在HTX后3个月内显著改善。因此，慢性心性肝病似乎是一种良性的、潜在可逆的疾病。
