Yokokawa Tetsuro, Sugimoto Koichi, Yoshihisa Akiomi, Goto Takuya, Misaka Tomofumi, Oikawa Masayoshi, Kobayashi Atsushi, Yamaki Takayoshi, Kunii Hiroyuki, Nakazato Kazuhiko, Ishida Takafumi, Takeishi Yasuchika
Department of Cardiovascular Medicine, Fukushima Medical University.
Department of Pulmonary Hypertension, Fukushima Medical University.
Int Heart J. 2019 Sep 27;60(5):1147-1153. doi: 10.1536/ihj.19-034. Epub 2019 Sep 4.
Heart failure causes increased venous pressure, leading to liver dysfunction. The fibrosis-4 index is a simple index for liver fibrosis and has been reported to be useful for predicting prognosis in heart failure; however, its impact on patients with pulmonary hypertension due to left heart disease (PH-LHD) has not yet been fully elucidated.We enrolled consecutive 230 hospitalized patients who had been diagnosed as having PH-LHD. The fibrosis-4 index was calculated as follows: [aspartate transaminase (U/L) × age]/[alanine transaminase (U/L) × platelet count (10/L) ]. We followed patients for all-cause mortality during the follow-up period (mean 1112 ± 822 days).The patients were divided into tertiles based on their fibrosis-4 index: the first tertile 0.335 to 1.381; the second tertile 1.391 to 2.311; and the third tertile 2.323 to 14.339. Compared with the first tertile, the third tertile had lower estimated glomerular filtration rates and hemoglobin levels. All-cause mortality was significantly higher in the third than in the first tertile. In a Cox proportional hazard model, the fibrosis-4 index was a predictor of all-cause mortality in PH-LHD patients (HR 1.212, 95% CI 1.099-1.337, P < 0.001).The fibrosis-4 index is associated with kidney function, anemia, and high mortality in PH-LHD patients.
心力衰竭会导致静脉压升高，进而引起肝功能障碍。纤维化-4指数是一种用于评估肝纤维化的简单指标，据报道对预测心力衰竭的预后有用；然而，其对左心疾病所致肺动脉高压（PH-LHD）患者的影响尚未完全阐明。
我们纳入了连续230例被诊断为PH-LHD的住院患者。纤维化-4指数的计算方法如下：[天冬氨酸转氨酶（U/L）×年龄]/[丙氨酸转氨酶（U/L）×血小板计数（10/L）]。我们对患者进行随访，观察随访期间的全因死亡率（平均1112±822天）。
根据纤维化-4指数将患者分为三个三分位数组：第一个三分位数组为0.335至1.381；第二个三分位数组为1.391至2.311；第三个三分位数组为2.323至14.339。与第一个三分位数组相比，第三个三分位数组的估算肾小球滤过率和血红蛋白水平较低。第三个三分位数组的全因死亡率显著高于第一个三分位数组。在Cox比例风险模型中，纤维化-4指数是PH-LHD患者全因死亡率的预测指标（风险比1.212，95%置信区间1.099-1.337，P<0.001）。
纤维化-4指数与PH-LHD患者的肾功能、贫血和高死亡率相关。
