Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites
Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites
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DOI：
10.1002/hep.510300613
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发表时间：
1999-12-01
期刊：
影响因子：
13.5
通讯作者：
Bernardi, M
中科院分区：
文献类型：
--
作者：
Trevisani, F;Sica, G;Bernardi, M
晚期肝硬化患者常表现出血流动力学异常。自主神经功能障碍（AD）也很常见，由于自主神经功能在心血管稳态中的重要性，它可能参与高动力循环的发病机制。因此，我们评估了30例肝硬化患者的血流动力学状态和自主神经功能，其中大多数是晚期疾病。自主神经功能进行了评估，探索迷走神经或交感神经功能的7个心血管测试。每项测试的评分为1 - 3分（正常、临界、改变）。通过超声心动图测量心脏指数（CI）。24例（80%）患者显示AD，其中14例（47%）患者明确为AD。在19名患者（63%）中发现迷走神经功能障碍（VD），这在II型患者（37%）中是明确的，在7名患者中发现交感神经功能障碍（SD）（在3名[10%]患者中是明确的）。与非AD患者相比，AD患者心率加快（P = 0.021），外周血管阻力降低（P = 0.013），CI增加（P = 0.004），而平均动脉压无差异。根据VD对患者进行分组也观察到类似的结果，AD评分与心率（r = 0.53; P = 0.002）和CI（r = 0.45; P = 0.016）直接相关，与外周血管阻力（r = 0.46; P = 0.013）呈负相关，与迷走神经评分的相关性更密切。AD（主要是VD）可能参与了晚期肝硬化高动力循环综合征的发病机制。
Patients with advanced cirrhosis frequently show hemodynamic abnormalities. Autonomic dysfunction (AD) is also common and, owing to the importance of autonomic function in cardiovascular homeostasis, it may be involved in the pathogenesis of the hyperdynamic circulation. We, therefore, evaluated the hemodynamic status and autonomic function in 30 patients with cirrhosis, most of them with an advanced stage of the disease. Autonomic function was assessed with 7 cardiovascular tests exploring the vagal or sympathetic function. Each test was scored from 1 to 3 (normal, borderline, altered). Cardiac index (CI) was measured by an echocardiogram. Twenty-four (80%) patients showed an AD, this being definite in 14 (47%) patients. A vagal dysfunction (VD) was found in 19 patients (63%), this being definite in II patients (37%), and a sympathetic dysfunction (SD) in 7 patients (definite in 3 [10%] patients). The patients with AD showed a faster heart rate (P = .021), lower indicized peripheral vascular resistance (P = .013), and increased CI (P = .004) than patients without AD whereas mean arterial pressure did not differ. Similar results were seen by grouping patients according to the VD, AD score was directly correlated with heart rate (r = 0.53; P = .002) and CI (r = 0.45; P = .016), and inversely correlated with peripheral vascular resistance (r = 0.46; P = .013), Even closer correlations were found with vagal score. AD (mainly VD) may be involved in the pathogenesis of the hyperdynamic circulatory syndrome of patients with advanced cirrhosis.