失代偿性慢性心力衰竭：通过瞬时弹性成像测量的肝硬度增加。
Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography.
机构信息
Department of Medicine, A. Manzoni Hospital, Via Dell'Eremo 9-11, Lecco 23900, Italy.
出版信息
Radiology. 2010 Dec;257(3):872-8. doi: 10.1148/radiol.10100013. Epub 2010 Oct 8.
PURPOSE
To analyze transient elastography-measured liver stiffness in patients with acute decompensated heart failure to describe variations in liver stiffness measurements and assess their relationship with the patients' clinical course and laboratory data.
MATERIALS AND METHODS
This study was approved by the local institutional review board, and all of the subjects gave verbal informed consent. Twenty-seven hospitalized patients with heart failure with no signs of liver disease (mean age, 79 years ± 12 [standard deviation]; 12 men [mean age, 78 years ± 11], 15 women [mean age, 80 years ± 12]) underwent liver stiffness and N-terminal proβ brain natriuretic peptide (NTproβBNP) assessments at admission, and 24 patients underwent stiffness measurements at discharge. (Three patients had failed measurement at admission; two of whom did not undergo measurement at discharge and one patient who died had only an admission value obtained.) The predefined stiffness cutoff values were greater than 7.65 kPa for substantial fibrosis and greater than 13.01 kPa for cirrhosis. The control subjects were 21 patients unaffected by heart failure or liver disease. The two groups were compared by using two-tailed Wilcoxon, Mann-Whitney, or t tests, as appropriate.
RESULTS
Among the patients with heart failure, median liver stiffness at admission was 8.80 kPa (interquartile range, 5.92-11.90 kPa), greater than 7.65 kPa in 14 (58%) cases and greater than 13.01 kPa in five (21%). During hospitalization, liver stiffness decreased in 18 patients (including all five patients with baseline measurement > 13.01 kPa) and increased in five. Median liver stiffness (P < .003) and NTproβBNP (P < .001) levels both significantly decreased during hospitalization. Liver stiffness was less than 7.65 kPa in all control patients and did not significantly change during hospitalization (P = .261).
CONCLUSION
Most patients with acute decompensated heart failure have high liver stiffness values which, like NTproβBNP levels, tend to decrease with clinical improvement.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100013/-/DC1.
目的
分析急性失代偿性心力衰竭患者的瞬时弹性成像测量的肝硬度，以描述肝硬度测量的变化，并评估其与患者临床病程和实验室数据的关系。
材料与方法
本研究经当地机构审查委员会批准，所有受试者均口头同意。27 例因心力衰竭住院且无肝病迹象的患者（平均年龄 79 岁±12[标准差]；12 名男性[平均年龄 78 岁±11]，15 名女性[平均年龄 80 岁±12]）在入院时接受了肝硬度和 N 末端 proβ脑利钠肽（NTproβBNP）评估，24 例患者在出院时接受了硬度测量。（3 例患者在入院时测量失败；其中 2 例在出院时未进行测量，1 例死亡患者仅获得入院值。）预设的硬度截断值为大于 7.65kPa 表示存在显著纤维化，大于 13.01kPa 表示存在肝硬化。对照组为 21 例未受心力衰竭或肝脏疾病影响的患者。采用双侧 Wilcoxon、Mann-Whitney 或 t 检验对两组进行比较，视情况而定。
结果
在心力衰竭患者中，入院时的中位肝硬度为 8.80kPa（四分位间距为 5.92-11.90kPa），14 例（58%）大于 7.65kPa，5 例（21%）大于 13.01kPa。住院期间，18 例患者（包括所有 5 例基线测量值>13.01kPa 的患者）的肝硬度下降，5 例患者的肝硬度增加。住院期间，肝硬度（P<.003）和 NTproβBNP（P<.001）水平均显著下降。所有对照组患者的肝硬度均小于 7.65kPa，且在住院期间无明显变化（P=.261）。
结论
大多数急性失代偿性心力衰竭患者的肝硬度值较高，与 NTproβBNP 水平一样，随着临床改善趋于降低。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100013/-/DC1.
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