Goncalvesova E, Kovacova M
Bratisl Lek Listy. 2018;119(2):98-102. doi: 10.4149/BLL_2018_018.
Liver dysfunction in heart failure is common and usually clinically significant, especially in patients with advanced or severe acute heart failure. Lesions are caused by an impaired hepatic circulation due to congestion and hypoperfusion. Congestive lesions are more common and typically manifested by painful hepatomegaly and increased direct bilirubin and alkaline phosphatase. The inferior vena cava and hepatic veins are usually dilated. Congestive lesions are characterized by dilatation of the central vein with fibrotic changes in the surrounding areas on histological examination. Isolated ischaemic lesions are rare and occur due to severe and prolonged ineffective perfusion, often accompanied by hypoxemia. Ineffective perfusion is reflected by an increase in total bilirubin and significantly increased transaminase levels. The prognosis of ischaemic lesions without an adequate treatment of the cause of hypoperfusion is poor. Increased levels of bilirubin and liver function tests, as well as signs of impaired liver proteosynthetic function, are associated with a poor prognosis. Knowledge of the phenotypes of hepatic lesions in heart failure is important to select the appropriate treatment for an acute decompensation. Changes in biochemical markers, hepatic perfusion or stiffness of the liver can be used to evaluate the effectiveness of diuretic treatment and achieve euvolemic status in the patients with heart failure (Tab. 1, Fig. 3, Ref. 28).
心力衰竭患者出现肝功能障碍很常见，且通常具有临床意义，尤其是在晚期或严重急性心力衰竭患者中。病变是由充血和灌注不足导致的肝循环受损引起的。充血性病变更为常见，典型表现为肝肿大伴疼痛、直接胆红素和碱性磷酸酶升高。下腔静脉和肝静脉通常扩张。组织学检查显示，充血性病变的特征是中央静脉扩张，周围区域有纤维化改变。孤立性缺血性病变罕见，是由于严重且持续的无效灌注所致，常伴有低氧血症。总胆红素升高和转氨酶水平显著升高反映了无效灌注。如果不对灌注不足的病因进行适当治疗，缺血性病变的预后较差。胆红素水平和肝功能检查结果升高，以及肝脏蛋白质合成功能受损的体征，均与预后不良相关。了解心力衰竭患者肝脏病变的表型对于选择急性失代偿的合适治疗方法很重要。生化标志物、肝脏灌注或肝脏硬度的变化可用于评估利尿剂治疗的效果，并使心力衰竭患者达到血容量正常状态（表1、图3、参考文献28）。
