Li Xiao-Peng, Yu Shan-Shan, Li Lu, Han Dong-Gang, Dai She-Jiao, Gao Ya
Department of Ultrasonic Medicine, Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710004, China. E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2015 Apr;35(4):557-61.
To investigate the changes of left ventricular structure and function in patients with liver cirrhosis and their correlation with the model for end-stage liver disease (MELD) score.
A total of 89 cirrhotic patients admitted between June, 2012 and June, 2014 and 30 healthy control subjects were enrolled in the study. According to MELD score, the cirrhotic patients were divided into 3 groups with MELD scores ≤9, between 10 and 19, and ≥20. The parameters of the left ventricle in resting state were measured using Doppler echocardiography, including left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left atrial diameter (LAD), ejection fraction (LVEF), cardiac output (CO), mitral flow velocity, and E wave deceleration time (DT), and evaluated their relationship with MELD score.
Compared with the control subjects, the cirrhotic patients showed significantly increased LVESD, LVEDD, IVST, LAD, CO and DT but reduced VE/VA ratio (P<0.05 or 0.01). The values of LVESD, LVEDD, IVST, LAD and DT increased gradually with MELD scores (P<0.05 or 0.01). VE/VA ratio was higher in patients with MELD score of 10-19 than in those with MELD score ≤9, and decreased significantly in those with MELD score ≥20. Of the cirrhotic patients, 55% were found to have left atrial enlargement and 44% had a VE/VA ratio ≤1; left atrial enlargement and a VE/VA ratio below 1 were more common in patients with a MELD score ≥20 than in those with lower MELD scores. The LAD, LVEDD and DT were positively correlated with MELD scores (r=0.208, 0.319 and 0.197, respectively; P<0.05 or 0.01).
The patients with liver cirrhosis can have cardiac function deficiency manifested mainly by left ventricular diastolic dysfunction in positive correlation with the severity of liver disease.
探讨肝硬化患者左心室结构和功能的变化及其与终末期肝病模型（MELD）评分的相关性。
选取2012年6月至2014年6月收治的89例肝硬化患者及30例健康对照者纳入研究。根据MELD评分，将肝硬化患者分为MELD评分≤9分、10至19分、≥20分3组。采用多普勒超声心动图测量静息状态下左心室参数，包括左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心房内径（LAD）、射血分数（LVEF）、心输出量（CO）、二尖瓣血流速度及E波减速时间（DT），并评估其与MELD评分的关系。
与对照组相比，肝硬化患者LVESD、LVEDD、IVST、LAD、CO及DT显著升高，VE/VA比值降低（P<0.05或0.01）。LVESD、LVEDD、IVST、LAD及DT值随MELD评分升高而逐渐增加（P<0.05或0.01）。MELD评分为10至19分患者的VE/VA比值高于MELD评分≤9分者，MELD评分≥20分者的VE/VA比值显著降低。肝硬化患者中，55%存在左心房扩大，44%的VE/VA比值≤1；MELD评分≥20分患者的左心房扩大及VE/VA比值<1较MELD评分低者更为常见。LAD、LVEDD及DT与MELD评分呈正相关（r分别为0.208、0.319及0.197；P<0.05或0.01）。
肝硬化患者可出现心功能不全，主要表现为左心室舒张功能障碍，且与肝病严重程度呈正相关。
