【摘要】 目的探讨急性左心衰竭(ALHF)和充血性心力衰竭(CHF)患者肝功能检测指标(LFTs)的差异。方法入选纽约心功能分级Ⅲ～Ⅳ级的心力衰竭患者137例,根据病情分为ALHF组59例和CHF组78例。收集患者的基本资料,比较两组LFTs和住院病死率的差异。结果与CHF组比较,ALHF组患者的谷丙转氨酶[(34.05±14.48)U/L比(29.41±9.16)U/L]、谷草转氨酶[(30.73±12.47)U/L比(26.64±6.81)U/L]和白蛋白[(38.62±2.70)g/L比(35.33±4.20)g/L]水平均显著升高(分别为t=-2.291,P=0.024;t=-2.454,P=0.015;t=-5.25,P<0.01),而谷氨酰氨基转移酶[(30.7±20.7)U/L比(41.5±32.3)U/L]、总胆红素[(14.22±7.21)μmol/L比(18.42±8.60)μmol/L]、直接胆红素[(6.28±3.46)μmol/L比(8.00±4.67)μmol/L]和间接胆红素[(7.99±4.82)μmol/L比(10.45±5.81)μmol/L]水平均降低(t=2.257,P=0.026;t=3.013,P=0.003;t=2.384,P=0.019;t=2.636,P=0.009)。两组患者的碱性磷酸酶[(75.93±29.01)U/L比(80.42±22.91)U/L]和总蛋白[(65.2±3.8)g/L比(65.9±7.8)g/L]水平差异无统计学意义(P>0.05)。ALHF组患者病死率较CHF组高[17例(28.8%)比8例(10.3%),χ2=7.754,P=0.005]。结论 ALHF患者以谷丙转氨酶、谷草转氨酶升高为主,与肝脏缺血相关,而CHF患者以谷氨酰氨基转移酶、总胆红素、直接胆红素、间接胆红素升高和白蛋白降低为主,与肝脏淤血相关。更多还原

【Abstract】 Objective To study the difference of the results of liver function tests(LFTs) between acute left heart failure(ALHF) and congestive heart failure(CHF) patients. Methods A total of 137 patients with severe heart failure(NYHA class Ⅲ-Ⅳ) were enrolled and divided into ALHF group(n=59) and CHF group(n=78) according to the clinical features.The results of LFTs and mortality during hospitalization were recorded and compared between the two groups. Results Compared to CHF group,patients in ALHF group had higher serum alanine aminotransferase(ALT) [(34.05±14.48) U/L vs.(29.41±9.16) U/L,t=-2.291,P=0.024],aspartate aminotransferase(AST) [(30.73±12.47) U/L vs.(26.64±6.81) U/L,t=-2.454,P=0.015]and albumin(ALB) [(38.62±2.70) g/L vs.(35.33±4.20) g/L,t=-5.25,P<0.01]level,and had lower serum γ-glutamyltransferase(GGT) [(30.7±20.7) U/L vs.(41.5±32.3) U/L,t=2.257,P=0.026],total bilirubin(TBIL) [(14.22±7.21) μmol/L vs.(18.42±8.60) μmol/L,t=3.013,P=0.003],direct bilirubin(DBIL) [(6.28±3.46) μmol/L vs.(8.00±4.67) μmol/L,t=2.384,P=0.019] and indirect bilirubin(IBIL) [(7.99±4.82) μmol/L vs.(10.45±5.81) μmol/L,t=2.636,P=0.009].Serum alkaline phosphate(ALP) [(75.93±29.01) U/L vs.(80.42±22.91) U/L,P>0.05],total protein(TP) [(65.2±3.8) g/L vs.(65.9±7.8) g/L,P>0.05] level were similar between the two groups. Conclusions Patients with ALHF have higher serum ALT and AST level maybe associated with hepatic ischemia.While patients with CHF have higher GGT,TBIL,DBIL,IBIL level and lower ALB level maybe associated with hepatic congestion.更多还原