肝硬化患者自主压力反射敏感性的无创评估

Noninvasive assessment of spontaneous baroreflex sensitivity in patients with liver cirrhosis.

作者信息

Veglio F, Melchio R, Calva S, Rabbia F, Gallo V, Molino P, Mengozzi G, Mulatero P, Martini G, Riva P, Chiandussi L

机构信息

Department of Medicine and Experimental Oncology, University of Turin, Italy.

出版信息

Liver. 1998 Dec;18(6):420-6. doi: 10.1111/j.1600-0676.1998.tb00827.x.

DOI:10.1111/j.1600-0676.1998.tb00827.x

PMID:9869397

Abstract

AIMS/BACKGROUND: An impairment of baroreceptor sensitivity has been found in liver cirrhosis. Noninvasive and spontaneous estimates of baroreflex sensitivity are obtained from beat-to-beat blood pressure and heart rate recordings by means of cross-spectrum analysis and calculation of alpha-index (as a measure of baroreflex gain). The aim of the present study was to investigate the function of the spontaneous baroreflex sensitivity related to clinical Child score in liver cirrhosis.

METHODS

The alpha-index was evaluated in 40 cirrhotic patients (18 with and 22 without ascites) and 17 healthy subjects by analysing finger arterial pressure recorded noninvasively with the Portapres device.

RESULTS

Baroreflex sensitivity was significantly lower in cirrhotic patients with and without ascites compared with healthy subjects (p<0.01). Furthermore, in patients with ascites the baroreflex gain was significantly related to plasma sodium (p<0.01). A significant inverse relationship was present between baroreflex gain and grade of Child score and the severity of ascites (p<0.01). There were no significant relationships between hormonal parameters (catecholamines, renin, aldosterone, arginine-vasopressin, atrial natriuretic peptide and nitric oxide) and baroreflex gain. No significant differences were found between healthy subjects and cirrhotic patients with respect to systolic and diastolic blood pressure total variability in a supine position, whilst it was lower in cirrhotic patients with ascites in a tilted position (p<0.05).

CONCLUSION

Our findings showed that baroreflex sensitivity was significantly impaired in cirrhotic patients when compared with healthy subjects. In addition, there was a significant trend toward lower baroreflex sensitivity values with the grade score of Child class (p<0.01). Spectral analysis of the alpha-index provides viable alternatives to the pharmacological approach for estimation of baroreflex sensitivity and may represent a prognostic tool to identify cirrhotic patients at increased risk of adverse events.

摘要

目的/背景：在肝硬化患者中发现压力感受器敏感性受损。通过交叉谱分析和α指数计算（作为压力反射增益的一种度量），从逐搏血压和心率记录中获得压力反射敏感性的无创和自发估计值。本研究的目的是探讨肝硬化患者中与临床Child评分相关的自发压力反射敏感性的功能。

方法

通过分析使用Portapres设备无创记录的手指动脉压，对40例肝硬化患者（18例有腹水，22例无腹水）和17名健康受试者进行α指数评估。

结果

与健康受试者相比，有腹水和无腹水的肝硬化患者的压力反射敏感性显著降低（p<0.01）。此外，在有腹水的患者中，压力反射增益与血钠显著相关（p<0.01）。压力反射增益与Child评分等级和腹水严重程度之间存在显著的负相关（p<0.01）。激素参数（儿茶酚胺、肾素、醛固酮、精氨酸加压素、心房利钠肽和一氧化氮）与压力反射增益之间无显著关系。健康受试者与肝硬化患者在仰卧位时收缩压和舒张压的总变异性方面无显著差异，而在倾斜位时，有腹水的肝硬化患者的总变异性较低（p<0.05）。