Grose R D, Nolan J, Dillon J F, Errington M, Hannan W J, Bouchier I A, Hayes P C
Department of Medicine, Royal Infirmary of Edinburgh, Scotland, UK.
J Hepatol. 1995 Mar;22(3):326-32. doi: 10.1016/0168-8278(95)80286-x.
BACKGROUND/AIMS: Autonomic and cardiac dysfunction have been reported in patients with cirrhosis. We studied left ventricular and autonomic function in 20 patients with both alcoholic and non-alcoholic cirrhosis.
Autonomic function was assessed by a standard battery of cardiovascular reflex tests. Supine exercise radionuclide ventriculography was used to assess the cardiac response to exercise.
Exercise capacity was reduced in all patients in association with marked chronotropic incompetence (peak heart rates 120.5 +/- 6 bpm). Unlike normal subjects there was no increase in left ventricular ejection fraction on exercise. Stroke volume increased by 23 +/- 6%, mediated by an increase in end-diastolic.volume of > 20%. Cardiac output was subnormal at maximal exercise, increasing by only 96 +/- 14% and 97 +/- 11% in alcoholic and non-alcoholic groups respectively. The majority (83%) of our patients had autonomic reflex abnormalities.
Patients with cirrhosis of alcohol and non-alcohol related aetiologies have significantly impaired cardiovascular responses to exercise, which are similar to those of a denervated heart. This may have important clinical implications for the ability of these patients to withstand cardiovascular stress.
背景/目的：已有报道称肝硬化患者存在自主神经功能和心脏功能障碍。我们对20例酒精性和非酒精性肝硬化患者的左心室功能和自主神经功能进行了研究。
通过一系列标准的心血管反射测试评估自主神经功能。采用仰卧位运动放射性核素心室造影评估运动时的心脏反应。
所有患者的运动能力均下降，伴有明显的变时性功能不全（峰值心率为120.5±6次/分钟）。与正常受试者不同，运动时左心室射血分数没有增加。每搏输出量增加23±6%，这是由舒张末期容积增加>20%介导的。最大运动时心输出量低于正常，酒精性和非酒精性组分别仅增加96±14%和97±11%。大多数（83%）患者存在自主神经反射异常。
酒精性和非酒精性病因所致肝硬化患者运动时的心血管反应明显受损，类似于去神经支配心脏的反应。这可能对这些患者承受心血管应激的能力具有重要的临床意义。
