肝硬化性心肌病患者临床特点、心电图表现和危险因素分析*

doi:10.3969/j.issn.1672-5069.2024.03.024

摘要/Abstract

摘要： 目的分析肝硬化性心肌病(CCM)患者的临床特点、心电图表现及其相关危险因素。方法 2020年5月～2023年5月我院诊治的肝硬化患者89例,常规行心电图检查和心脏超声检查,测量左房内径(LAD)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、舒张期室间隔厚度(IVSD)、左室射血分数(LVEF)和二尖瓣舒张早期峰速/晚期峰速(E/A)比值,应用多因素Logistic回归分析CCM发生的危险因素。结果在89例肝硬化患者中,诊断CCM者21例(23.6%);并发CCM者LAD和IVSD分别为(38.7±4.4) mm和(11.8±1.7)mm,显著大于肝硬化患者【分别为(35.3±3.9)mm和(10.0±1.5)mm,P<0.05】,而E/A比值为(0.8±0.1),显著小于肝硬化患者【(1.3±0.2,P<0.05】;并发CCM患者Q-T间期延长、ST-T改变和低电压发生率分别为76.2%、66.7%和28.6%,显著高于肝硬化患者的35.3%、30.9%和5.9%(P<0.05);并发CCM患者年龄、肝功能Child-Pugh C级、门静脉直径、血清肌酐(sCr)、PT和Hb水平与未并发CCM的肝硬化患者比,差异显著 (P<0.05);多因素Logistic回归分析显示,年龄(OR=1.54,95%CI=1.09～2.17)、肝功能Child-Pugh C级(OR=2.78,95%CI=1.18～6.56)和低水平Hb(OR=2.58,95%CI=1.29～5.14)是诱发肝硬化患者CCM发生的独立危险因素。结论由于高动力循环状态,肝硬化患者容易并发CCM,而年龄大、肝功能状态差和低Hb血症可能是诱发因素,应特别注意观察和预防。

关键词: 肝硬化性心肌病, 超声心动图, 心电图, 危险因素

Abstract: Objective The aim of this study was to summarize the clinical feature, electrocardiogram manifestations and related risk factors in patients with cirrhotic cardiomyopathy (CCM). Methods 89 patients with liver cirrhosis were enrolled in our hospital between May 2020 and May 2023, and all underwent digital electrocardiograph (EKG). The echocardiogram was conducted to record the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), diastolic interventricular septal thickness (IVSD), left ventricular ejection fraction (LVEF), and mitral valve early diastolic peak velocity/late peak velocity (E/A) ratio. The multivariate Logistic regression analysis was applied to predict the risk factors of CCM occurrence. Results Out the 89 patients with liver cirrhosis, 21 cases (23.6%) were found complicated with CCM; the LAD and IVSD in patients with CCM were (38.7±4.4) mm and (11.8±1.7)mm, significantly greater than [(35.3±3.9)mm and (10.0±1.5)mm, respectively, P<0.05], while the E/A ratio was (0.8±0.1), much less than [(1.3±0.2, P<0.05] in liver cirrhosis patients without CCM; the percentages of prolonged Q-T intervals, ST-T changes and limb lead low voltage in patients with CCM were 76.2%, 66.7% and 28.6%, much higher than 35.3%, 30.9% and 5.9%(P<0.05) in liver cirrhosis patients without CCM; there were significant differences as respect to the ages, Child-Pugh class C, diameters of portal vain, serum creatinine (sCr) levels, prothrombin times and hemoglobin (Hb) levels between the two groups (P<0.05); the multivariate Logistic regression analysis showed that the age (OR=1.54, 95%CI=1.09-2.17), the liver function Child-Pugh class C (OR=2.78, 95%CI=1.18-6.56) and hypohemoglobinemia (OR=2.58, 95%CI=1.29-5.14) were the independent risk factors of CCM occurrence in patients with liver cirrhosis. Conclusion Because of the hyperkinetic circulatory state, the patients with decompensated liver cirrhosis might have the complications of CCM, especially in elderly patients with deteriorated liver functions and hypohemoglobinemia, and the clinicians should pay more attention to them.

Key words: Cirrhotic cardiomyopathy, Echocardiogram, Electrocardiogram, Risk factors

朱春芬, 任春霖, 郭霞. 肝硬化性心肌病患者临床特点、心电图表现和危险因素分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 414-417.

Zhu Chunfen, Ren Chunlin, Guo Xia. Clinical feature, electrocardiogram findings and risk factors in patients with cirrhotic cardiomyopathy[J]. Journal of Practical Hepatology, 2024, 27(3): 414-417.

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肝硬化性心肌病患者临床特点、心电图表现和危险因素分析^*

Clinical feature, electrocardiogram findings and risk factors in patients with cirrhotic cardiomyopathy

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