1040例肝硬化患者心脏手术的长期预后——基于全国人群的队列研究
Long-Term Outcome of Cardiac Surgery in 1,040 Liver Cirrhosis Patient - Nationwide Population-Based Cohort Study.
作者信息
Chou An-Hsun, Chen Tien-Hsing, Chen Chun-Yu, Chen Shao-Wei, Lee Chao-Wei, Liao Chien-Hung, Wang Shang-Yu
机构信息
Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University.
出版信息
Circ J. 2017 Mar 24;81(4):476-484. doi: 10.1253/circj.CJ-16-0849. Epub 2017 Feb 3.
BACKGROUND
Patients with liver cirrhosis (LC) have a higher risk for cardiac surgery, but population-based long-term follow-up studies are lacking. The aim of this study was therefore to validate the long-term outcome of cardiac surgery in patients with LC.
METHODS AND RESULTS
Data were obtained from Taiwan's National Health Insurance Database, 1997-2011. This study included 1,040 LC patients and 1,040 matched controls without LC. The actuarial survival rate at 1, 5 and 10 years in the LC cohort was 68%, 50% and 41%: significantly lower than that of the control cohort at 81%, 68% and 62% at 1, 5 and 10 years after cardiac surgery. Compared with the matched control cohort, the LC group had a higher risk of liver and heart failure readmission (P<0.001) during the follow-up period. In addition, the LC cohort had a higher risk of liver causes of death than did the control cohort (12.6% vs. 1.2%). In the LC cohort, 51% of deaths were due to hepatocellular carcinoma. And in the LC group, those with valve surgery and advanced cirrhosis had a lower survival rate (P=0.002, P=0.001).
CONCLUSIONS
Even after successful cardiac surgery, long-term outcome is unsatisfactory in LC patients because of the progressive deterioration of liver function.
背景
肝硬化（LC）患者进行心脏手术的风险较高，但缺乏基于人群的长期随访研究。因此，本研究的目的是验证LC患者心脏手术的长期预后。
方法与结果
数据来源于1997 - 2011年台湾国民健康保险数据库。本研究纳入了1040例LC患者和1040例匹配的无LC对照者。LC队列1年、5年和10年的精算生存率分别为68%、50%和41%，显著低于心脏手术后1年、5年和10年对照队列的81%、68%和62%。与匹配的对照队列相比，LC组在随访期间因肝衰竭和心力衰竭再次入院的风险更高（P<0.001）。此外，LC队列因肝脏原因导致的死亡风险高于对照队列（12.6%对1.2%）。在LC队列中，51%的死亡归因于肝细胞癌。在LC组中，接受瓣膜手术和晚期肝硬化患者的生存率较低（P = 0.002，P = 0.001）。
结论
即使心脏手术成功，由于肝功能的进行性恶化，LC患者的长期预后仍不令人满意。
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