Ospedali Riuniti University Hospital, Foggia, Italy.
Department of Medical & Surgical Sciences, University of Foggia, Italy.
Eur J Intern Med. 2018 Feb;48:25-34. doi: 10.1016/j.ejim.2017.10.016.
In their clinical practice, physicians can face heart diseases (chronic or acute heart failure) affecting the liver and liver diseases affecting the heart. Systemic diseases can also affect both heart and liver. Therefore, it is crucial in clinical practice to identify complex interactions between heart and liver, in order to provide the best treatment for both. In this review, we sought to summarize principal evidence explaining the mechanisms and supporting the existence of this complicate cross-talk between heart and liver. Hepatic involvement after heart failure, its pathophysiology, clinical presentation (congestive and ischemic hepatopathy), laboratory and echocardiographic prognostic markers are discussed; likewise, hepatic diseases influencing cardiac function (cirrhotic cardiomyopathy). Several clinical conditions (congenital, metabolic and infectious causes) possibly affecting simultaneously liver and heart have been also discussed. Cardiovascular drug therapy may present important side effects on the liver and hepato-biliary drug therapy on heart and vessels; post-transplantation immunosuppressive drugs may show reciprocal cardio-hepatotoxicity. A heart-liver axis is drafted by inflammatory reactants from the heart and the liver, and liver acts a source of energy substrates for the heart.
在临床实践中，医生可能会面临影响肝脏的心脏疾病（慢性或急性心力衰竭）和影响心脏的肝脏疾病。系统性疾病也会同时影响心脏和肝脏。因此，在临床实践中识别心脏和肝脏之间的复杂相互作用至关重要，以便为两者提供最佳治疗。在这篇综述中，我们试图总结主要证据，解释机制并支持心脏和肝脏之间存在这种复杂的交叉对话。讨论了心力衰竭后肝脏受累、其病理生理学、临床表现（充血性和缺血性肝病）、实验室和超声心动图预后标志物；同样，影响心脏功能的肝脏疾病（肝硬化性心肌病）。还讨论了可能同时影响肝脏和心脏的几种临床情况（先天性、代谢性和传染性原因）。心血管药物治疗可能对肝脏有重要的副作用，肝-胆药物治疗可能对心脏和血管有副作用；移植后免疫抑制药物可能表现出相互的心脏-肝脏毒性。心脏-肝脏轴由心脏和肝脏的炎症反应物组成，肝脏是心脏能量底物的来源。
