肝硬化患者心功能改变与终末期肝病模型评分的相关性研究

目的  研究肝硬化患者心功能的改变，探讨其与终末期肝病模型（MELD）评分的相关性。方法  应用心脏彩超检测反映心脏收缩、舒张功能的指标，将不同终末期肝病模型MELD评分的心功能进行比较，分析其相关性。结果  肝硬化患者心功能与MELD评分的关系：MELD≤9分患者的左室射血分数（LVEF）为（58.12±0.18）%，二尖瓣舒张早期流速峰值（E）/二尖瓣舒张晚期流速峰值（A）值为（1.04±0.03），左房直径（Las）为（30.48±0.36）mm；MELD 10～19分患者的LVEF为（60.58±1.21）%，E/A值为（0.78±0.03），LAs为（27.14±0.56）mm；MELD≥20分患者的LVEF为（56.71±0.54）%，E/A值（0.53±0.01），LAs为（34.12±0.72）mm。MELD评分3者间两两比较显示，①MELD≤9分、10～19分肝硬化患者的LVEF值均高于MELD≥20分患者，MELD≤9分患者的LVEF值与MELD 10～19分患者比较、MELD 10～19分患者的LVEF值与MELD≥20分患者比较，差异有统计学意义（P <0.05）。②E/A值随MELD评分逐步降低，MELD评分3者间两两比较差异有统计学意义（P <0.05），Spearman相关性检验显示，E/A值与MELD评分呈负相关，相关系数为-0.935，P <0.05；MELD≥20分肝硬化患者的LAs高于MELD≤9分、10～19分患者，不同MELD评分肝硬化患者的Las比较，差异有统计学意义（P <0.05）。结论  肝硬化患者可出现心功能受损，其程度随肝功能的恶化而加重。

Correlation between heart function changes and score of model for end-stage liver disease in patients with liver cirrhosis

Objective To study the changes of cardiac function in patients with liver cirrhosis and their relationship with the score of model for end-stage liver disease (MELD). Methods Cardiac systolic and diastolic functions were detected by echocardiography, and the correlation between MELD score and end-stage liver disease model was analyzed. Results The relationships between MELD score and cardiac functions in patients with liver cirrhosis were as follows: in the patients with MELD score ≤ 9, LVEF was (58.12 ± 0.18)%, E/A was (1.04 ± 0.03), LAs was (30.48 ± 0.36) mm; in the patients with MELD score of 10-19, LVEF was (60.58 ± 1.21)%, E/A was (0.78 ± 0.03), LAs was (27.14 ± 0.56) mm; in the patients with MELD score ≥20, LVEF was (56.71 ± 0.54)%, E/A was (0.53 ± 0.01), LAs was (34.12 ± 0.72) mm. LVEF values in the patients with MELD score ≤ 9 and MELD score of 10-19 were higher than that in the patients with MELD score ≥ 20; the LVEF value in the patients with MELD score of 10-19 was significantly different from those in the patients with MELD score ≤9 and MELD score ≥ 20 (P < 0.05). The E/A value decreased gradually with the increasing of MELD scores, there were significant differences among the three groups with different MELD scores (P < 0.05). Spearman correlation test showed that E/A was negatively correlated with the MELD score, the correlation coefficient was -0.935 (P < 0.05); LAs in the patients with MELD score ≥20 was higher than that in the patients with MELD score ≤ 9 and MELD score of 10-19 with significant differences among the three groups with different MELD scores (P < 0.05). Conclusions In patients with liver cirrhosis, heart function is impaired, which is aggravated with the deterioration of liver function.