Wiese Signe, Mortensen Christian, Gøtze Jens P, Christensen Erik, Andersen Ove, Bendtsen Flemming, Møller Søren
Department of Clinical Physiology and Nuclear Medicine, Center of Functional and Diagnostic Imaging and Research, Copenhagen, Denmark; Gastro Unit, Medical Department, Hvidovre Hospital, Hvidovre, Denmark.
Liver Int. 2014 Jul;34(6):e19-30. doi: 10.1111/liv.12428. Epub 2014 Jan 7.
BACKGROUND & AIMS: Inflammation and cardiac dysfunction plays an important role in the development of complications leading to increased mortality in patients with cirrhosis. Novel cardiac markers such as prohormone of ANP (proANP), copeptin and high-sensitivity troponin T (hs-TnT) and proinflammatory markers including soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitive C-reactive protein (hs-CRP) are related to these complications. We aimed to investigate if cardiac and proinflammatory markers are related to severity of liver disease, cardiac and haemodynamic changes, and long-term survival.
One hundred and ninety-three stable cirrhotic patients (Child class: A = 46; B = 97; C = 50) had a full haemodynamic investigation performed with measurement of splanchnic and systemic haemodynamics and measurement of circulating levels of proBNP, proANP, copeptin, hs-TnT, LBP, IL 6, IL 8, IP 10, VEGF, hs-CRP and suPAR.
Soluble urokinase-type plasminogen activator receptor soluble urokinase-type plasminogen activator receptor, hs-CRP, and hs-TnT were significantly different throughout the Child classes (P < 0.01; P < 0.01; P < 0.02). All markers except copeptin correlated with indicators of disease severity in cirrhosis; ProANP and suPAR correlated with hepatic venous pressure gradient (r = 0.24 and r = 0.34; P < 0.001) and systemic vascular resistance (r = -0.24 and r = -0.33; P < 0.001). Cardiac (proANP, hs-TnT; P < 0.01) and proinflammatory (hs-CRP, suPAR; P < 0.05) markers were associated with mortality in a univariate Cox analysis, however, the strongest predictors of mortality in a multivariate Cox analysis were hs-TnT, ascites and hepatic venous pressure gradient (reg.coeff.: 0.34, P < 0.001; 0.16, P < 0.001; 0.06, P = 0.04).
Markers of cardiac dysfunction and inflammation are significantly associated with disease severity, degree of portal hypertension and survival in cirrhosis. In particular, hs-TnT and suPAR seem to contain prognostic information.
炎症和心脏功能障碍在肝硬化患者并发症的发生发展中起重要作用，这些并发症会导致死亡率升高。新型心脏标志物如心钠素原（proANP）、 copeptin和高敏肌钙蛋白T（hs-TnT）以及促炎标志物包括可溶性尿激酶型纤溶酶原激活物受体（suPAR）和高敏C反应蛋白（hs-CRP）与这些并发症相关。我们旨在研究心脏和促炎标志物是否与肝病严重程度、心脏和血流动力学变化以及长期生存相关。
193例病情稳定的肝硬化患者（Child分级：A = 46例；B = 97例；C = 50例）进行了全面的血流动力学检查，包括测量内脏和全身血流动力学以及检测循环中的proBNP、proANP、copeptin、hs-TnT、LBP、IL-6、IL-8、IP-10、VEGF、hs-CRP和suPAR水平。
可溶性尿激酶型纤溶酶原激活物受体、hs-CRP和hs-TnT在不同Child分级患者中存在显著差异（P < 0.01；P < 0.01；P < 0.02）。除copeptin外，所有标志物均与肝硬化疾病严重程度指标相关；ProANP和suPAR与肝静脉压力梯度（r = 0.24和r = 0.34；P < 0.001）以及全身血管阻力（r = -0.24和r = -0.33；P < 0.001）相关。在单因素Cox分析中，心脏标志物（proANP、hs-TnT；P < 0.01）和促炎标志物（hs-CRP、suPAR；P < 0.05）与死亡率相关，然而，在多因素Cox分析中，死亡率的最强预测因素是hs-TnT、腹水和肝静脉压力梯度（回归系数：0.34，P < 0.001；0.16，P < 0.001；0.06，P = 0.04）。
心脏功能障碍和炎症标志物与肝硬化疾病严重程度、门静脉高压程度及生存显著相关。特别是，hs-TnT和suPAR似乎包含预后信息。
