Kubo S H, Walter B A, John D H, Clark M, Cody R J
Arch Intern Med. 1987 Jul;147(7):1227-30.
To characterize the incidence and severity of liver function abnormalities in patients with congestive heart failure, we analyzed systemic hemodynamics and biochemical profiles in 133 patients with stable chronic congestive heart failure, secondary to a dilated cardiomyopathy. The patients were divided into three groups, based on the severity of the reduction in cardiac index (CI). The mean values of all liver function tests in groups 1 (n = 43; CI greater than or equal to 2.0 L/min/m2) and 2 (n = 48; CI greater than 1.5 and less than 2.0 L/min/m2) were essentially normal, except for minimally elevated alkaline phosphatase levels and slightly decreased albumin levels in both groups, and slight increases in levels of gamma-glutamyl transpeptidase and total bilirubin in group 2. In contrast, group 3 patients (n = 42; CI less than or equal to 1.5 L/min/m2) had the most severe heart failure, as assessed by the lowest CI and highest cardiac filling pressures, and significantly higher levels of aspartate aminotransferase (65 +/- 82 U/L), alanine aminotransferase (77 +/- 102 U/L), lactate dehydrogenase (282 +/- 91 U/L), and total bilirubin (29 +/- 14 mumol/L [1.7 +/- 0.8 mg/dL]). The percentage of patients in group 3 with these abnormalities ranged between 27% and 80%. Although linear regression analysis showed that the elevations in right atrial and pulmonary wedge pressures, and the decreases in CI, were significantly correlated with liver function abnormalities, the correlation coefficients were small. Thus, liver function abnormalities remain common in patients with congestive heart failure but are generally small in magnitude and not associated with clinically apparent hepatic disease. It is likely that reduced forward flow and passive backward congestion are both contributing factors in the pathogenesis of these biochemical abnormalities, although nonhemodynamic factors may also be important.
为了明确充血性心力衰竭患者肝功能异常的发生率及严重程度，我们分析了133例因扩张型心肌病导致的稳定慢性充血性心力衰竭患者的全身血流动力学和生化指标。根据心脏指数（CI）降低的严重程度，将患者分为三组。第1组（n = 43；CI大于或等于2.0 L/min/m²）和第2组（n = 48；CI大于1.5且小于2.0 L/min/m²）所有肝功能检查的平均值基本正常，只是两组的碱性磷酸酶水平略有升高、白蛋白水平略有降低，第2组的γ-谷氨酰转肽酶和总胆红素水平略有升高。相比之下，第3组患者（n = 42；CI小于或等于1.5 L/min/m²）心力衰竭最为严重，其CI最低、心脏充盈压最高，天冬氨酸转氨酶（65±82 U/L）、丙氨酸转氨酶（77±102 U/L）、乳酸脱氢酶（282±91 U/L）和总胆红素（29±14 μmol/L [1.7±0.8 mg/dL]）水平显著更高。第3组中出现这些异常的患者比例在27%至80%之间。虽然线性回归分析显示右心房压和肺楔压升高以及CI降低与肝功能异常显著相关，但相关系数较小。因此，肝功能异常在充血性心力衰竭患者中仍然常见，但一般程度较轻，且与临床上明显的肝病无关。尽管非血流动力学因素可能也很重要，但前向血流减少和被动性逆向充血可能都是这些生化异常发病机制中的促成因素。
