Sun Fu-rong, Meng Yi-man, Wang Bing-yuan, Liu Yong-feng, Liu Cui-xiang, Xie Da-wei, Ding Yuan-yuan, Li Jin-ping, Ma Li
First Affiliated Hospital of China Medical University, Shenyang 110001, China.
Zhonghua Gan Zang Bing Za Zhi. 2010 Oct;18(10):758-62. doi: 10.3760/cma.j.issn.1007-3418.2010.10.009.
To evaluate the correlations between MELD score and left ventricular function in patients with end-stage liver disease.
A total of 92 patients who prepared for orthotopic liver transplantation from January 2002 to May 2008 were enrolled in this study. Of these Patients, 75 were males and 17 were females, and the mean age was 50.3+/-9.5 years; 85 were cirrhosis, 7 were cirrhosis with primary liver cancer. Preoperative information, including biochemical parameters, coagulation parameters, indicators of hepatitis virology, two-dimensional echocardiography and electrocardiogram were collected. According to MELD (the Model for End-stage Liver Disease) scoring system, these subjects were categorized into three groups: MELD score is less than or equal to 9 points (31 cases, 33.7%); 10 is less than or equal to MELD score is less than or equal to 19 points (45 cases, 48.9%); MELD score is more than or equal to 20 points (16 cases, 17.4%). The relationships between MELD score and classification and cardiac function were determined by chi-square test, analysis of variance, rank sum test and correlation analysis, et al.
MELD score was significantly correlated with left atrial diameter (LAD), interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVEDD), aortic flow (AF), cardiac output (CO), QRS interval (QRSI) and corrected QT interval (QTc) (r = 0.317, 0.341, 0.228, 0.387, 0.325, 0.209 and 0.347, respectively; P value less than 0.01, respectively); except QRSI, these variables and left ventricular posterior wall thickness (LVPWT) were also correlated with INR (a MELD component) (r = 0.282, 0.319, 0.322, 0.435, 0.275, 0.320 and 0.237, respectively; P value less than 0.01, respectively); LAD, LVEDD, AF, CO and QTc were correlated with serum total bilirubin (r = 0.241, 0.219, 0.357, 0.246 and 0.253, respectively; P value less than 0.05, respectively); IVST and E/A ratio (A blood flow [from left atrium to left ventricular] velocity ratio between early diastole [E wave] and late diastole[A wave] ) were correlated with serum creatinine (r = 0.216 and -0.343; P value less than 0.05 and 0.01); the proportion of E/A is less than or equal to 1 in all subjects was 46.7% (43/92), and 48.4% (15/31), 35.6% (16/45) and 75.0% (12/16) in each group, besides, there was statistically significant difference between 10 is less than or equal to MELD score is less than or equal to 19 points group and MELD score is more than or equal to 20 points group (X2 = 7.359, P = 0.009).
There are different degrees of left ventricular structure, function and electrophysiological changes in patients with end-stage liver disease, these anomalies also will be increased with the MELD score increasing.
评估终末期肝病患者的终末期肝病模型（MELD）评分与左心室功能之间的相关性。
选取2002年1月至2008年5月准备进行原位肝移植的92例患者纳入本研究。其中男性75例，女性17例，平均年龄为50.3±9.5岁；85例为肝硬化，7例为肝硬化合并原发性肝癌。收集术前信息，包括生化参数、凝血参数、肝炎病毒学指标、二维超声心动图和心电图。根据MELD（终末期肝病模型）评分系统，将这些受试者分为三组：MELD评分小于或等于9分（31例，33.7%）；10≤MELD评分≤19分（45例，48.9%）；MELD评分≥20分（16例，17.4%）。采用卡方检验、方差分析、秩和检验及相关性分析等方法确定MELD评分与分类及心功能之间的关系。
MELD评分与左心房内径（LAD）、室间隔厚度（IVST）、左心室舒张末期内径（LVEDD）、主动脉血流（AF）、心输出量（CO）、QRS波时限（QRSI）和校正QT间期（QTc）显著相关（r分别为0.317、0.341、0.228、0.387、0.325、0.209和0.347；P值均小于0.01）；除QRSI外，这些变量与左心室后壁厚度（LVPWT）也与INR（MELD的一个组成部分）相关（r分别为0.282、0.319、0.322、0.435、0.275、0.320和0.237；P值均小于0.01）；LAD、LVEDD、AF、CO和QTc与血清总胆红素相关（r分别为0.241、0.219、0.357、0.246和0.253；P值均小于0.05）；IVST和E/A比值（舒张早期[E波]与舒张晚期[A波]之间的A血流[从左心房到左心室]速度比值）与血清肌酐相关（r分别为0.216和-0.343；P值分别小于0.05和0.01）；所有受试者中E/A≤1的比例为46.7%（43/92），每组分别为48.4%（15/31）、35.6%（16/45）和75.0%（12/16），此外，10≤MELD评分≤19分组与MELD评分≥20分组之间差异有统计学意义（X2 = 7.359，P = 0.009）。
终末期肝病患者存在不同程度的左心室结构、功能及电生理改变，且这些异常会随着MELD评分的增加而加重。
