摘要
目的探讨肝功能异常在慢性收缩性心力衰竭（心衰）患者发病率及对预后影响。方法回顾性调查和分析湖北地区8地市12家三级甲等医院2000至2010年心衰住院患者临床资料，所有患者电话随访。根据患者预后分为死亡组和存活组。以单因素和多因素Cox生存分析确认肝功能异常与心衰患者预后关系；双变量相关分析肝功能指标与其他因素的相关性。结果16681例患者纳入本次研究。任一肝功能指标异常的发生率为71．94％（12001／16681）。最常见的为直接胆红素（DBil）升高，γ-谷氨酰转移酶（γ-GT）升高和丙氨酸转氨酶（ALT）升高，分别为33．37％（4863／14574）、32．51％（4337／13341）和30．12％（5024／16681）。碱性磷酸酶（ALP）异常少见，其减低和升高分别为4．51％（559／12397）和3．82％（474／12397）。白蛋白（Alb）减低占23．24％（3408／14664），总胆红素（TBil）升高占19．37％（3231／16681）。DBil升高（HR1．264，95％CI1．103—1．423；P=0．02）、TBil升高（HR1．126，95％CI1．019—1．234；P=0．02）和Alb降低（HR0．889，95％C10．794～0．889；P〈0．01）是心衰总死亡率增加的独立危险因素。相关性分析发现DBil、TBil和Alb与左心室射血分数（LVEF）（r=-0．235，P〈0．01；r=-0．209，P〈0．01；r=0．107，P〈0．01）和右心室舒张末期内径（r=0．149，P〈0．01；r=0．154，P〈0．01；r=-0．086，P〈0．01）相关。结论DBil升高、Alb降低和TBil升高是心衰总死亡率增加的独立危险因素。LVEF减低和右心室舒张末期内径增加是影响慢性收缩性心衰患者肝功能的主要因素。
Objective To evaluate systemically the prevalence and prognostic values of liver function abnormalities in patients with chronic systolic heart failure （HF） have not been systematically evaluated. Methods A total of 16 681 hospitalized patients with a diagnosis of chronic systolic HF and left ventricular ejection fraction （LVEF） 〈 50% were recruited from 12 hospitals in Hubei Province. All patients were followed up by telephone contacts. And they were divided into the death and survival groups according to the follow-up results. Results Over a median follow-up period of 3 years, 6453 （38. 69% ） patients died. The prevalence of liver function abnormality was 71.94% （ 12 001/16 681 ）. The elevations of direct bilirubin, γ-glutamyl-transferase and alanine aminotransferase were the most common findings accounting for 33. 37 % （4863/14 574）, 32. 51% （4337/13 341 ） and 30. 12% （5024/16 681 ） respectively. The abnormality of alkaline phosphatase was rare and its increase and decrease accounted for 3. 82% （474/12 397） and 4. 51% （559/12 397 ） respectively. The prevalence of low albumin and total bilirubin elevation was 23.24% （3408/14 664） and 19. 37% （3231/16 681）. And high direct bilirubin （HR 1. 264, 95% CI 1. 103 - 1. 423 ; P = 0. 02）, high total bilirubin （ HR 1.126, 95 % CI 1.019 - 1. 234 ; P = 0. 02） and low albumin （ HR 0. 889, 95% CI 0.794 -0. 889; P 〈 0.01 ）were determined as the independent risk factors of total mortality. There were the correlations of LVEF with direct bilirubin（ r = - 0. 235, P 〈 0. 01 ） , total bilirubin （ r = - 0. 209, P 〈 0. 01 ）, albumin （ r = 0. 107, P 〈 0. 01 ） and right ventricular end-diastolic diameter （RVDD） with direct bilirubin（r = 0. 149, P 〈 0. 01 ）, total bilirubin （ r = 0. 154, P 〈 0. 01 ） and albumin （r = - 0. 086, P 〈 0. 01 ）. Conclusion The prevalence of liver function abnormalities is high in patientswith chronic systolic HF. Low albumin, high direct bilirubin and high total bilirubin increase their total mortalities. Low LVEF and high RVDD are positively correlated with a high prevalence of liver function abnormalities.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第38期2673-2677,共5页
National Medical Journal of China
关键词
心力衰竭
充血性
肝功能不全
预后
回归分析
Heart failure, congestive
Hepatic insufficiency
Prognosis
Regression analysis
