Voiosu Andrei M, Daha Ioana C, Voiosu Theodor A, Mateescu Bogdan R, Dan Gheorghe A, Băicuş Cristian R, Voiosu Mihail R, Diculescu Mircea M
Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania.
"Carol Davila" University of Medicine, Bucharest, Romania.
Liver Int. 2015 Dec;35(12):2547-55. doi: 10.1111/liv.12866. Epub 2015 May 29.
BACKGROUND & AIMS: Extrahepatic complications of cirrhosis increase the risk for decompensation of the liver disease and death. Previous studies show common pathogenetic mechanisms involved in the development of hepatopulmonary syndrome and cirrhotic cardiomyopathy. We aimed to assess the link between these entities and their effect on disease-related patient morbidity and mortality.
Seventy-four consecutive cirrhotic patients without prior history of cardiovascular and pulmonary disease were included in a prospective observational study. Routine blood work, arterial blood gas analysis, pulse oximetry measurements, N-terminal pro-brain natriuretic peptide levels and contrast enhanced echocardiography examination with tissue Doppler imaging were performed in all patients. Patients were followed up for a median of 6 months and disease-related adverse events and death were the main outcomes tested. Statistical analysis was conducted according to the presence of hepatopulmonary syndrome or cirrhotic cardiomyopathy.
Hepatopulmonary syndrome was diagnosed in 17 patients (23%) and cirrhotic cardiomyopathy in 30 patients (40.5%). There was no association between the presence of cirrhotic cardiomyopathy and the existence of mild or moderate hepatopulmonary syndrome. No echocardiographic parameters were useful in predicting the presence of hepatopulmonary syndrome. N-terminal pro-brain natriuretic peptide levels and length of QT interval did not aid in diagnosis of cirrhotic cardiomyopathy. Neither entity had significant influence on disease-related outcomes in the follow-up period.
Hepatopulmonary syndrome and cirrhotic cardiomyopathy are independent complications arising in cirrhosis and have a limited influence on morbidity and mortality on a pre-liver transplantation population.
肝硬化的肝外并发症会增加肝病失代偿和死亡风险。既往研究显示肝肺综合征和肝硬化性心肌病的发生涉及共同的发病机制。我们旨在评估这些病症之间的联系及其对疾病相关患者发病率和死亡率的影响。
74例无心血管和肺部疾病既往史的连续肝硬化患者纳入一项前瞻性观察性研究。对所有患者进行常规血液检查、动脉血气分析、脉搏血氧饱和度测量、N末端脑钠肽前体水平检测以及组织多普勒成像的对比增强超声心动图检查。对患者进行了中位时间为6个月的随访，疾病相关不良事件和死亡是主要检测结局。根据肝肺综合征或肝硬化性心肌病的存在情况进行统计分析。
17例患者（23%）诊断为肝肺综合征，30例患者（40.5%）诊断为肝硬化性心肌病。肝硬化性心肌病的存在与轻度或中度肝肺综合征的存在之间无关联。没有超声心动图参数可用于预测肝肺综合征的存在。N末端脑钠肽前体水平和QT间期长度无助于肝硬化性心肌病的诊断。在随访期间，这两种病症对疾病相关结局均无显著影响。
肝肺综合征和肝硬化性心肌病是肝硬化中出现的独立并发症，对肝移植前人群的发病率和死亡率影响有限。
