CAJ | 학술논문

目的评价终末期肝病患者终末期肝病模型(MELD)评分与左心功能的关系.方法回顾性分析2002年1月-2008年5月进行原位肝移植的患者92例的术前临床资料.其中男性75例,女性17例,年龄(50.3±9.5)岁;85例为肝硬化,7例同时伴有原发性肝癌.分析资料包括血液生物化学指标、凝血指标,肝炎病毒学标志物和二维心脏超声、心电图等.根据MELD评分系统将其分为3组:MELD评分≤9分31例;10分≤MELD评分≤19分45例; MELD评分≥20分16例.采用x2检验、方差分析,秩和检验和相关分析等方法判断MELD评分与心功能之间的关系.结果 MELD评分与左房内径(LAD)、室间隔厚度(IVST)、左室舒张末期内径(LVEDD)、主动脉瓣流速(AF)、心输出量(CO)、QRS间期(QRSI)、校正的QT间期(QTc)等呈正相关,r分别为0.317,0.341,0.228,0.387,0.325,0.209和0.347;P值均＜0.01;除QRSI外,上述指标及左室后壁厚度亦与国际标准化比率呈正相关,r分别为0.282,0.319,0.322,0.435,0.275,0.320和0.237;P＜0.05或P＜0.01; LAD、LVEDD、AF,CO、QTc与血清总胆红素呈正相关,r值分别为0.241,0.219,0.357,0.246和0.253;P值均＜0.05;IVST和二尖瓣流速E/A与血清肌酐相关,r值分别为0.216和-0.343;P＜0.05或P＜0.01.E/A≤1在研究对象中的比例为46.7%(43/92),在MELD分级的3组中比例分别为48.4%(15/31),35.6%(16/45)和75.0%(12/16),其中,MELD 10～19分组和MELD评分≥20分组间,x2=7.359,P=0.009,差异有统计学意义.结论随着终末期肝病的进展,心脏的结构,功能及电生理活动逐渐减退.
목적 평개종말기간병환자종말기간병모형(MELD)평분여좌심공능적관계.방법 회고성분석2002년1월-2008년5월진행원위간이식적환자92례적술전림상자료.기중남성75례,녀성17례,년령(50.3±9.5)세;85례위간경화,7례동시반유원발성간암.분석자료포괄혈액생물화학지표、응혈지표,간염병독학표지물화이유심장초성、심전도등.근거MELD평분계통장기분위3조:MELD평분≤9분31례;10분≤MELD평분≤19분45례; MELD평분≥20분16례.채용x2검험、방차분석,질화검험화상관분석등방법판단MELD평분여심공능지간적관계.결과 MELD평분여좌방내경(LAD)、실간격후도(IVST)、좌실서장말기내경(LVEDD)、주동맥판류속(AF)、심수출량(CO)、QRS간기(QRSI)、교정적QT간기(QTc)등정정상관,r분별위0.317,0.341,0.228,0.387,0.325,0.209화0.347;P치균＜0.01;제QRSI외,상술지표급좌실후벽후도역여국제표준화비솔정정상관,r분별위0.282,0.319,0.322,0.435,0.275,0.320화0.237;P＜0.05혹P＜0.01; LAD、LVEDD、AF,CO、QTc여혈청총담홍소정정상관,r치분별위0.241,0.219,0.357,0.246화0.253;P치균＜0.05;IVST화이첨판류속E/A여혈청기항상관,r치분별위0.216화-0.343;P＜0.05혹P＜0.01.E/A≤1재연구대상중적비례위46.7%(43/92),재MELD분급적3조중비례분별위48.4%(15/31),35.6%(16/45)화75.0%(12/16),기중,MELD 10～19분조화MELD평분≥20분조간,x2=7.359,P=0.009,차이유통계학의의.결론 수착종말기간병적진전,심장적결구,공능급전생리활동축점감퇴.
Objective To evaluate the correlations between MELD score and left ventricular function in patients with end-stage liver disease. Methods Atotal of 92 patients who prepared for orthotopic liver transplantation from January 2002 to May 2008 were enrolled in this study. Of these Patients, 75 were males and 17 were females, and the mean age was 50.3 ± 9.5 years; 85 were cirrhosis, 7 were cirrhosis with primary liver cancer. Preoperative information, including biochemical parameters, coagulation parameters, indicators of hepatitis virology, two-dimensional echocardiography and electrocardiogram were collected. According to MELD (the Model for End-stage Liver Disease) scoring system, these subjects were categorized into three groups: MELD score ≤ 9 points (31 cases, 33.7%); 10 ≤ MELD score ≤ 19 points (45 cases, 48.9%);MELD score ≥ 20 points (16 cases, 17.4%). The relationships between MELD score and classification and cardiac function were determined by chi-square test, analysis of variance, rank sum test and correlation analysis,et al. Results MELD score was significantly correlated with left atrial diameter (LAD), interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVEDD), aortic flow (AF), cardiac output (CO), QRS interval (QRSI) and corrected QT interval (QTc) (r = 0.317, 0.341, 0.228, 0.387, 0.325, 0.209 and 0.347, respectively; P ＜ 0.01, respectively); except QRSI, these variables and left ventricular posterior wall thickness (LVPWT) were also correlated with INR (a MELD component) (r = 0.282, 0.319, 0.322, 0.435,0.275, 0.320 and 0.237, respectively; P ＜ 0.01, respectively); LAD, LVEDD, AF, CO and QTc were correlated with serum total bilirubin (r = 0.241, 0.219, 0.357, 0.246 and 0.253, respectively; P ＜ 0.05, respectively);IVST and E/A ratio (A blood flow [from left atrium to left ventricular] velocity ratio between early diastole [E wave] and late diastole[A wave] ) were correlated with serum creatinine (r = 0.216 and -0.343; P ＜ 0.05 and 0.01); the proportion of E/A ≤ 1 in all subjects was 46.7% (43/92), and 48.4% (15/31), 35.6% (16/45) and 75.0% (12/16) in each group, besides, there was statistically significant difference between 10 ≤ MELD score ≤ 19 points group and MELD score ≥ 20 points group ( x 2 = 7.359, P = 0.009). Conclusions There are different degrees of left ventricular structure, function and electrophysiological changes in patients with end-stage liver disease, these anomalies also will be increased with the MELD score increasing.