Cardiac hepatopathy before and after heart transplantation
Cardiac hepatopathy before and after heart transplantation
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DOI：
10.1111/j.1432-2277.2005.00122.x
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发表时间：
2005-06-01
影响因子：
3.1
通讯作者：
Pölzl, G
中科院分区：
文献类型：
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作者：
Dichtl, W;Vogel, W;Pölzl, G
慢性心源性肝病是接受心脏移植（HTX）评估的患者的常见病症。肝损伤是由长期反复充血和/或动脉灌注受损引起的严重心力衰竭引起的。尚无关于接受 HTX 的患者心脏性肝病可逆性的数据。对 2000 年 2 月在因斯布鲁克大学医院连续接受 HTX 的 56 名成年患者的数据进行了回顾性分析。以下参数在上市时以及 HTX 后 3、6 和 12 个月进行了评估。 γ-谷氨酰转移酶 (γ-GT)、碱性磷酸酶 (AP)、胆红素、天冬氨酸转氨酶 (AST)、丙氨酸转氨酶 (ALT)、乳酸脱氢酶 (LDH) 和血浆总蛋白的血浆水平。当列出 HTX 时，所有分析的患者中只有 12% 在评估的七个实验室参数中具有生理值。所有患者的 γ-GT、AP、胆红素、AST、ALT、LDH 和血浆总蛋白水平分别升高，分别为 66.6%、29%、50%、16.7%、10%、40% 和 18%。因此，γ-GT、胆红素和 LDH 的中位血浆水平升高，而 AP 的平均血浆水平处于正常范围上限。相比之下，AST 的中位血浆水平以及 ALT 和总血浆蛋白的平均血浆水平均在正常范围内：γ-GT（中位，109.0；范围，634.0 U/l；n = 36），AP（中位，120.2 ± 78.9 U/l；n = 29），胆红素（中位，1.3；范围，16.1 mg/dl；n = 32)、LDH（中位数，226.0；范围，2355.0 U/l；n = 33）、AST（中位数，29.0；范围，145.0 U/l；n = 36）、ALT（平均值，28.3 ± 20.8 U/l；n = 36）和总血浆蛋白（平均值，7.2 ± 1.1 g/dl；n = 25）。 HTX 后 3 个月内，除 LDH 外的升高参数均显着改善：γ-GT（中位数，59.0；范围，1160.0 U/I；P=0.011）、AP（92.2 ± 75.2 U/I；P=0.016）、胆红素（中位数，0.9；范围，8.1 mg/dl；P= 0.004）、LDH 轻微改善增加（中位数，281.0；范围，543.0 U/l；P = 0.039），但在 HTX 后 6 个月和 12 个月后，该参数的改善有所延迟。终末期心力衰竭的特点是胆汁淤积性肝酶谱，血浆 γ-GT 和胆红素水平升高。 HTX 后 3 个月内这些参数显着改善。因此，慢性心源性肝病似乎是一种良性的、潜在可逆的疾病。
Chronic cardiac hepatopathy is a common entity in patients evaluated for heart transplantation (HTX). Hepatic injury is caused by severe heart failure resulting from prolonged recurrent congestion and/or impaired arterial perfusion. No data are available on the reversibility of cardiac hepatopathy in patients undergoing HTX. Data of 56 consecutive adult patients undergoing HTX during 2000-02 at the University Hospital of Innsbruck were analysed retrospectively. The following parameters were evaluated at the time of listing and 3, 6 and 12 months after HTX. Plasma levels of gamma-glutamyl transferase (γ-GT), alkaline phosphatase (AP), bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and total plasma protein. When listed for HTX, only 12% of all patients analysed had physiological values throughout the seven laboratory parameters assessed. Elevated levels of γ-GT, AP, bilirubin, AST, ALT, LDH and total plasma protein were detected in 66.6%, 29%, 50%, 16.7%, 10%, 40% and 18% of all patients respectively. Accordingly, median plasma levels of γ-GT, bilirubin and LDH were elevated, whereas the mean plasma level of AP was at the upper normal range. In contrast, median plasma level of AST and mean plasma levels of ALT and total plasma protein were within the normal range: γ-GT (median, 109.0; range, 634.0 U/l; n = 36), AP (mean, 120.2 ± 78.9 U/l; n = 29), bilirubin (median, 1.3; range, 16.1 mg/dl; n = 32), LDH (median, 226.0; range, 2355.0 U/l; n = 33), AST (median, 29.0; range, 145.0 U/l; n = 36), ALT (mean, 28.3 ± 20.8 U/l; n = 36) and total plasma protein (mean, 7.2 ± 1.1 g/dl; n = 25). Within 3 months after HTX, elevated parameters except LDH significantly ameliorated: γ-GT (median, 59.0; range, 1160.0 U/I; P=0.011), AP (92.2 ± 75.2 U/I; P=0.016), bilirubin (median, 0.9; range, 8.1 mg/dl; P= 0.004), LDH slightly increased (median, 281.0; range, 543.0 U/l; P = 0.039), but there was a delayed improvement of this parameter after 6 and 12 months post-HTX. End-stage heart failure is characterized by a cholestatic liver enzyme profile with elevated plasma levels of γ-GT and bilirubin. These parameters significantly improve within 3 months after HTX. Therefore, chronic cardiac hepatopathy seems to be a benign, potentially reversible disease.