当心脏杀死肝脏时:充血性心力衰竭继发急性肝衰竭

When the heart kills the liver: acute liver failure in congestive heart failure

摘要
充血性心力衰竭作为急性肝衰竭的原因很少有文献记载，只有少数病例。

尽管对病理生理学的了解甚少，但越来越多的证据表明，肝血流量连续减少的低心排血量是主要的病因，而不是低血压。在由充血性心力衰竭引起的急性肝功能衰竭的背景下，后者的临床征象可能不存在，这需要一个合适的诊断方法。

作为急性肝衰竭和肝移植的参考中心，我们从2003年5月到2007年12月记录了202例急性肝衰竭的主要诊断。13/202为充血性心力衰竭，死亡率为54%。死亡的主要原因是潜在的心力衰竭。

在入院时，天冬酰胺转氨酶(AST)、胆红素和国际标准化比率(INR)在生存率和死亡人数上没有显著差异。尽管两组均有心源性休克的迹象，但入院时存活组的心脏指数(CI)明显高于非存活组(2.1 L/min/m2 vs. 1.6 L/min/m2, p = 0.04)。中心静脉-肺动脉楔压与肺动脉楔压无显著差异。本组患者的肝功能有明显改善，均已从心源性休克中恢复。

　

总之，急性肝功能衰竭患者需要一个合适的诊断方法。充血性心力衰竭是急性肝功能衰竭的可能原因之一。

关键词:急性肝衰竭，充血性心力衰竭，多普勒超声

　

　

When the heart kills the liver: acute liver failure in congestive heart failure


Abstract
Congestive heart failure as a cause of acute liver failure is rarely documented with only a few cases.

Although the pathophysiology is poorly understood, there is rising evidence, that low cardiac output with consecutive reduction in hepatic blood flow is a main causing factor, rather than hypotension. In the setting of acute liver failure due to congestive heart failure, clinical signs of the latter can be absent, which requires an appropriate diagnostic approach.

As a reference center for acute liver failure and liver transplantation we recorded from May 2003 to December 2007 202 admissions with the primary diagnoses acute liver failure. 13/202 was due to congestive heart failure, which was associated with a mortality rate of 54%. Leading cause of death was the underlying heart failure. Asparagine transaminase (AST), bilirubin, and international normalized ratio (INR) did not differ significantly in surviving and deceased patients at admission. Despite both groups had signs of cardiogenic shock, the cardiac index (CI) was significantly higher in the survival group on admission as compared with non-survivors (2.1 L/min/m2 vs. 1.6 L/min/m2, p = 0.04). Central venous - and pulmonary wedge pressure did not differ significantly. Remarkable improvement of liver function was recorded in the group, who recovered from cardiogenic shock.

In conclusion, patients with acute liver failure require an appropriate diagnostic approach. Congestive heart failure should always be considered as a possible cause of acute liver failure.

Keywords: Acute liver failure, congestive heart failure, Doppler ultrasound

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351940/