Prognostic value of noninvasive cardiac hemodynamics detection in patients with chronic hepatitis B-induced cirrhosis
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摘要: 目的无创血流动力检测法研究不同阶段乙型肝炎肝硬化患者心脏血流动力学变化,探讨心脏泵功能与肝硬化预后的关系。方法 20例慢性乙型肝炎患者作为对照,以45例乙型肝炎肝硬化患者为研究对象,根据Child-Pugh分级分为A级组(12例)、B级组(17例)和C级组(16例),根据食管静脉曲张程度分为轻度组(10例)、中度组(17例)和重度组(18例),根据病毒载量分为高病毒载量组(105拷贝/ml)(19例)和低病毒载量组(≤105拷贝/ml)(26例),采用无创血流动力检测仪测定心脏血流动力学参数。结果随着肝功能恶化,平均动脉压(MAP)、每搏出量(SV)、每搏指数(SI)、心输出量(CO)、心脏指数(CI)、左心作功(LCW)和左心作功指数(LCWI)呈降低趋势,其中C级组明显低于A级组(P<0.05)。随着食管静脉曲张程度的加重,MAP、SV、SI、CO、CI、LCW和LCWI呈降低趋势,其中重度组明显低于轻度组(P<0.05)。不同病毒载量组间MAP、SV、SI、CO、CI、LCW和LCWI差异无统计学意义(P>0.05)。结论心脏血流动力学参数可有效判断乙型肝炎肝硬...Abstract: Objective To investigate the cardiac hemodynamics profile inpatients with chronic hepatitis B (CHB) -induced cirrhosis of varying degrees and to clarify the relationship between cardiac muscle systolic function and prognosis of portal hypertension.Methods Forty-five CHB patients with cirrhosis and 20 CHB control patients without cirrhosis were divided into groups according to Child-Pugh score [Child-Pugh A (n=12) , Child-Pugh B (n=17) , and Child-Pugh C (n=16) ], esophageal varices [mild (n=10) , moderate (n=17) , and severe (n=18) ], and viral load [high (>105 copies/ml, n=19) and low (≤105 copies/ml, n=26) ].Cardiac hemodynamic parameters were investigated by standard noninvasive procedures.Results Greater extents of liver dysfunction were correlated with detrimental deceases in mean arterial pressure (MAP) , stroke volume (SV) , stroke index (SI) , cardiac output (CO) , cardiac index (CI) , left cardiac work (LCW) , and left cardiac work index (LCWI) , which in the Child-Pugh C group were significantly lower than in the mild group (P<0.05) .Greater extents of esophageal varices degradation were correlated with detrimental decreases in MAP, SV, SI, CO, CI, LCW, and LCWI, which in the severe group were significantly lower than in the Child-Pugh A group (P<0.05) .There were no significant differences between the hemodynamic parameters of the high viral load group and the low viral load group (P>0.05) .Conclusion Cardiac hemodynamic parameters could be an effective prognostic measure of CHB-induced cirrhosis.The extent of degradation of cardiac muscle systolic function is correlated with extent of liver dysfunction and degradation of esophageal varices.
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Key words:
- hepatitis B /
- liver cirrhosis /
- hemodynamics
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