Evlice Mert, Bedir Ömer, Coşkun Mükremin, Paçacı Emre, Cerşit Sinan, Öcal Lütfi, Gürsoy Mustafa Ozan, Şen Ömer, Kurt İbrahim Halil
Department of Cardiology, Health Sciences University -Adana City Training and Research Hospital, Adana, Turkey.
Department of Cardiology, Health Sciences University -Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey.
Echocardiography. 2023 Apr;40(4):350-358. doi: 10.1111/echo.15556. Epub 2023 Mar 27.
It has been shown that the increase in volume and pressure in the right heart chambers increases liver stiffness. The Albumin-Bilirubin (ALBI) score is a useful and easy-to-use score for objectively assessing liver function. There is no information in the literature about changes in ALBI score in patients with atrial septal defect (ASD). The aim of our study is to investigate the changes in ALBI score and its clinical impact in patients with ASD.
Of the 206 analyzed patients, 77 were excluded. The remaining 129 patients with secundum type ASD with left to right shunt were divided into three groups; Group I (16 patients with Qp/Qs < 1.5 and defect diameter < 10 mm), Group II (52 patients with Qp/Qs > 1.5 and defect diameter 10-20 mm) and Group III (61 patients with Qp/Qs > 1.5 and defect diameter > 20 mm). The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI = (log10 bilirubin [umol/L] * .66) + (albumin [g/L] * -.085).
ALBI scores as well as total bilirubin levels, transaminases, and functional-structural heart abnormalities (increase in RA and RV dimensions, sPAP, ASD size and decrease in LVEF and TAPSE) showed a significant increasing trend from Group I to Group III (p < .001 for all comparisons). The mean ALBI scores for Group I, Group II, and Group III were -3.71 ± .37, -3.51 ± .25, and -3.27 ± .34, respectively. In multivariate linear regression analysis, ASD size, sPAP, RV-RA diameter were found to be significantly associated with increased ALBI score.
The ALBI score offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in patients with ASD. ASD size, sPAP, RV and RA diameters were significantly associated with ALBI score.
研究表明，右心腔的容积和压力增加会导致肝脏硬度增加。白蛋白-胆红素（ALBI）评分是一种客观评估肝功能的实用且易于使用的评分方法。文献中没有关于房间隔缺损（ASD）患者ALBI评分变化的信息。我们研究的目的是调查ASD患者ALBI评分的变化及其临床影响。
在206例分析患者中，77例被排除。其余129例继发孔型ASD伴左向右分流的患者分为三组；第一组（16例Qp/Qs < 1.5且缺损直径 < 10 mm），第二组（52例Qp/Qs > 1.5且缺损直径10 - 20 mm）和第三组（61例Qp/Qs > 1.5且缺损直径 > 20 mm）。使用以下公式根据血清白蛋白和总胆红素水平计算ALBI评分：ALBI = （log10胆红素[umol/L] *.66） + （白蛋白[g/L] * -.085）。
从第一组到第三组，ALBI评分以及总胆红素水平、转氨酶和功能性-结构性心脏异常（右心房和右心室尺寸增加、收缩期肺动脉压、ASD大小增加以及左心室射血分数和三尖瓣环平面收缩期位移降低）均呈现出显著的上升趋势（所有比较p <.001）。第一组、第二组和第三组的平均ALBI评分分别为-3.71 ±.37、-3.51 ±.25和-3.27 ±.34。在多变量线性回归分析中，发现ASD大小、收缩期肺动脉压、右心室-右心房直径与ALBI评分增加显著相关。
ALBI评分提供了一种简单、基于证据、客观且具有区分性的方法来评估ASD患者的肝功能。ASD大小、收缩期肺动脉压、右心室和右心房直径与ALBI评分显著相关。
