急性心源性肝损害临床特征与预后分析

目的:探讨急性心源性肝损害的临床特征、诊治经验及预后。方法:收集急性心脏疾病并心源性肝损害的患者24例,记录其临床资料及肝功能演变过程,分析其病因、临床特征及预后。14例不伴明显肝损害的急性心脏病患者作为对照组。结果:急性心源性肝损害发病基础病因各异,并非只发生于肝脏缺血患者;急性心源性肝损害患者肝功能损害突出,经原发病治疗后多数迅速好转,1周后丙氨酸氨基转移酶(ALT)由高峰期(2 981±979)U/L降为(659±870)U/L,AST由高峰期(2 743±967)U/L降为(706±830)U/L,少数肝功能恶化,其中2例死于肝衰竭。结论:急性心源性肝损害临床上需要更多重视,其病因及机制与多种因素有关,临床转归多数良好,少数恶化。     

心力衰竭所致淤血性肝损害的预后分析

心力衰竭（简称心衰）引起的淤血性肝损害尚未引起临床警惕，常常误诊为病毒性肝炎或肝硬化的报道。为探讨心衰与肝功能损害的关系，及对心衰患者的预后影响。现将我院1998年9月至2004年9月收治的120例心衰患者中肝功能异常者40例的临床资料分析如下。     

恙虫病肝损害临床分析

恙虫病是由立克次体引起的一种急性感染性疾病,常有肾脏、肺脏及心脏损害,而肝功能损害易忽视,本文对65例恙虫病患者的肝功能损伤状况进行分析。 1 临床资料 1997年～2001年住院确诊的恙虫病人65例。其中37例无慢性肝病史,无嗜酒史及食生鱼史,检测前无使用损肝药物史,检查甲～戊型肝炎病毒标志均为阴性,可排除其它原因肝损害,定为单纯组;28例有慢肝病史,定为重叠组。65例均有野外活动     

肝纤维化评价指标对心力衰竭预后价值的研究进展

心力衰竭由于其居高不下的患病率及病死率一直是影响我国的国民健康的重大医疗问题,心力衰竭常引起其他脏器功能障碍,增加心力衰竭诊疗难度,进一步降低患者预后,增加患者死亡率。心肝相互作用已被证实,心源性肝损伤产生的相关化验检查异常结果也许对心力衰竭有一定预后价值,本文就对心衰有预后价值肝纤维化评价指标作一综述。     

登革热并发肝损害的临床特点

目的：探讨登革热患者并发肝损害的临床特点。方法：对2007年8月至10月收治的125例登革热患者的临床资料进行分析。结果：101例患者出现肝功能异常，ALT异常者58例，占46．4％，AST异常者100例，占80．0％，转氨酶大多数为轻度到中度升高，以AST升高为著，经治疗肝功能可在发病2—3周内恢复正常。结论：登革热患者并发肝损害较多，肝功能指标的特征性改变可作为登革热临床诊断的重要参考依据。     

急性胰腺炎合并肝损害临床分析

目的分析急性胰腺炎合并肝损害的临床特点。方法回顾性分析2009年2月至2012年8月西安市中心医院收治的116例急性胰腺炎患者的临床资料。结果67％（78／116）的急性胰腺炎患者合并肝损害。按病因分类,胆源性胰腺炎合并肝损害者的发病率为79％（38／48）,胰胆手术后（含胆囊切除术后及经内镜逆行性胰胆管造影术后）所致的急性胰腺炎合并肝损害的发病率为68％（15／22）,暴饮暴食所致的急性胰腺炎合并肝损害的发病率为67％（20／30）,其他因素所致的急性胰腺炎合并肝损害的发生率低。胆源性胰腺炎较非胆源性胰腺炎肝功能损害更明显,总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、碱性磷酸酶浓度差异均有统计学意义（t值分别为3．16、3．72、4．12、3．26、3．64、3．25,P均〈0．01）。结论胆源性胰腺炎患者大多合并肝损害。     

不同组方中药对大鼠免疫性肝损害作用的研究

为研究中药对注射人血清白蛋白致大鼠免疫性肝损害的作用,比较了不同组方中药的效果。结果表明中药煎剂组的存活率最高(87.5％),在降低ALT、AST、血清球蛋白、升高血清白蛋白方面的作用优于其他各组。其他活血化瘀中药均有不同程度的减轻肝损害,治疗肝纤维化的作用,并与秋水仙碱的作用相似。中药煎剂对免疫性肝损害的治疗作用优于其他各组,对肝炎后肝纤维化也有较好疗效,值得深入研究。     

甘利欣对肺癌化疗药物性肝损害的防治作用

近年来甘利欣注射液在临床上应用越来越广泛[1～3].我们观察了它对肺癌化疗药物性肝损害的防治作用,报道如下.     

Acute cardiogenic liver injury caused by heart failure in an adolescent

To the Editor: Heart failure is a systemic clinical syndrome characterized by multiple organ systems involvements [1] . With the progression of heart failure, p...     

Intravenous thyroid hormone supplementation in heart failure with cardiogenic shock

BACKGROUND: Thyroid hormone level abnormalities commonly exist in severe heart failure and may be of prognostic value. The therapeutic potential of using thyroid hormone for cardiogenic shock resulting from progressive heart failure has not been previously delineated. We sought to evaluate the role of an intravenous infusion of thyroxine as an adjunct to conventional inotropic agents and intra-aortic balloon counterpulsation in patients with severe heart failure with cardiogenic shock. METHODS AND RESULTS: We studied 10 consecutive patients with severe systolic heart failure that progressed to a cardiogenic shock state unresponsive to conventional pharmacological inotropic measures. Intravenous thyroxine (20 micrograms/h) was used as an adjunctive salvage measure after the failure of conventional pharmacological and mechanical support by intra-aortic balloon pump. The invasive hemodynamic profile (right atrial pressure, pulmonary capillary wedge pressure, cardiac index, mean arterial pressure), overall clinical status, core temperature, renal function, and tachyarrhythmias were compared before and sequentially at 6, 24, and 36 hours after the initiation of thyroxine administration. Long-term outcome was also defined. All patients had statistically significant improvements in cardiac index, pulmonary capillary wedge pressure, and mean arterial pressure at 24 and 36 hours post-initiation of thyroxine. No sustained tachyarrhythmias were seen during the thyroxine infusion. In 9 of 10 patients who underwent left ventricular assist device placement and/or heart transplantation, the use of thyroxine served as an effective adjunctive measure to allow transitioning to definitive surgical therapy. The 6-month and 1-year cohort survival rates, achieved by the transition to surgical therapy, were 90% and 80%, respectively. CONCLUSION: The beneficial hemodynamic properties of intravenous thyroid hormone can be effectively used in otherwise terminal situations of cardiogenic shock, and in such situations, the use of thyroid hormone can serve as a pharmacological adjunct to a definite surgical intervention. Further studies in larger numbers of patients might be warranted to confirm these findings.     

The liver in heart failure

Severe congestive heart failure is associated with two distinct forms of liver dysfunction: jaundice that is related to passive congestion and acute hepatocellular necrosis that is caused by impaired perfusion. Cardiac cirrhosis (fibrosis) may result from prolonged recurrent congestive heart failure. Ischemic hepatitis (shock liver) usually manifests as asymptomatic elevation of the serum aminotransferase levels after an episode of hypotension, although the clinical presentation may mimic that of acute viral hepatitis. In most cases, ischemic hepatitis is of little clinical consequence and is self-limited. Acute liver failure may occur in patients with preexisting cirrhosis, severe chronic heart failure, or sustained hepatic ischemia.     

经皮冠状动脉介入治疗急性心肌梗死伴心力衰竭、心源性休克的疗效分析

目的观察ST段抬高的急性心肌梗死(AMI)伴心力衰竭(心衰)、心源性休克患者经皮冠状动脉介入(PCI)治疗的近期和中期疗效。方法206例ST抬高AMI患者,伴心衰和(或)休克90例。对心衰和(或)心源性休克患者行PCI58例、药物溶栓20例、一般治疗12例(未行再灌注组);比较PCI组和溶栓组的住院时间、住院及随访期间不良心血管事件发生率、心功能恢复情况,观察PCI组血管开通时间、TIMI血流与预后的关系。结果PCI组、溶栓组血管开通率分别为98.3%和65.0%(P<0.01),平均住院时间分别为15.3天±3.5天和20.5天±4.4天,住院及随访期间死亡率PCI组6.9%,溶栓组25%(P<0.05)。PCI组两亚组术后心功能恢复均好于溶栓组(P<0.01和P<0.05)。结论PCI与溶栓相比,能及时开通血管且开通率高,术后心功能恢复较好,安全有效,可作为首选。     

Effects of intraaortic balloon pumping on acute myocardial infarction in 64 cases of cardiogenic shock, severe heart failure and mechanical heart failure

Of the patients treated in the CCU of Nippon Medical School for acute myocardial infarction in the past 5 years and 8 months, 44 with cardiogenic shock, 11 with severe heart failure, 7 with ventricular septal perforation and 2 with mitral regurgitation were treated by IABP. The peak effect of IABP on the hemodynamics of patients with cardiogenic shock was noted 24 hours after starting on IABP. When hemodynamics were compared between surviving and dead groups, there was a significant difference in stroke volume index between the two groups. When left ventricular function was compared between them, it was suggested that patients whose left ventricular function does not respond to IABP for 48 hours or longer are more likely to die than responders. Twenty-four of 44 patients became independent of IABP, but no more than 13 patients (30%) survived for 6 months or longer. Isosorbide dinitrate (ISDN) was combined with IABP in 7 patients who had a persistence of heart failure in spite of IABP. Combination therapy with IABP and ISDN elicited a significant increase in cardiac index, a significant decrease in pulmonary capillary wedge pressure, mean pulmonary arterial pressure and total peripheral resistance and a pronounced improvement in left ventricular function, and all 7 patients became independent of IABP. In the patients with acute myocardial infarction complicated with ventricular septal perforation, the mean systolic arterial pressure was 87.7 +/- 8.3 mmHg, mean pulmonary capillary wedge pressure, 20.3 +/- 7.4 mmHg and pulmonary-to-systemic flow ratio, 3.12 +/- 0.95 before starting on IABP. When the hemodynamics at 3 hours of IABP were compared to the pre-IABP values, the right atrial pressure, pulmonary capillary wedge pressure and pulmonary-to-systemic flow ratio had a tendency to decline, but the changes were not statistically significant, except for the peak arterial pressure which showed a significant elevation at 3 hours of IABP. Three of the 7 patients became dependent on IABP, and 2 of the 3 patients were saved by emergency operation.     

Microvascular alterations in patients with acute severe heart failure and cardiogenic shock

Background

Microvascular blood flow alterations may impair tissue oxygenation and may participate in the development of multiple organ failure in patients with severe heart failure. We hypothesized that microvascular blood flow alterations are present in patients with severe heart failure and cardiogenic shock.

Methods

We used an orthogonal polarization spectral imaging technique to investigate the sublingual microcirculation in 40 patients with acute severe heart failure, including 31 patients with cardiogenic shock, and in a control group of 15 patients who were examined the day before cardiac surgery. The effects of topical application of acetylcholine (10-2M) were also tested in 5 patients with cardiogenic shock. Five sublingual areas were recorded, allocated a random number, and later analyzed semiquantitatively. Data were analyzed with non-parametric tests and presented as medians (percentiles 25-75).

Results

The density of all the vessels was similar in the 3 groups. The proportion of perfused small (<20 μm) vessels was lower in patients with cardiac failure and cardiogenic shock than in control patients (63% [46%-65%] and 49% [38%-64%] vs 92% [90%-93%] , P <.001). The perfusion of large vessels was preserved in all groups. The proportion of perfused vessels was higher in patients who survived than in patients who did not survive in all vessels (90% [84%-93%] vs 81% [74%-87%] , P <.05) and in small vessels (64% [49%-68%] vs 43% [37%-62%], P <.05). The topical application of acetylcholine totally reversed these alterations

Conclusions

Microvascular blood flow alterations are frequently observed in patients with severe heart failure and are more severe in patients who do not survive.     

慢性心力衰竭与肾损害

流行病学调查结果显示,心血管疾病的危险因素如高血压、糖尿病、脂代谢紊乱、吸烟和代谢综合征等同样是慢性肾脏疾病的危险因素.心血管疾病的新型标志物包括肌钙蛋白、N-末端脑利钠肽前体、胱抑素和超敏C-反应蛋白等不仅可以预测所有人群的心血管原性死亡,同时也是肾原性死亡的重要预测因素,并受肾排泌能力下降等因素的干扰~([1]).     

慢加急性肝衰竭的免疫损伤机制研究进展

慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)是一种独特的肝病类型,病死率高,严重威胁公众健康。该病的显著特点为高病死率和高强度的全身炎症反应,其发病是一个多因素、多环节、多通路的复杂免疫病理过程,其中直接的物理损害和免疫介导的肝损伤是两个主要因素。近年来ACLF成为肝病领域的研究热点,本文就其免疫损伤机制的研究进展作一综述。