Proprandol Has An Influence On Portal System Hemodynamics And Tei Index In Patients With Liver Cirrhosis

Objective: The investigation will apply Colour doppler echocardiography to detect portal vein hemodynamics and Tei index in cirrhosis of liver before and after proprandol treatment in cirrhosis of liver, and will examine the health adult in order to compare to hepatic cirrhosis patient at the same time. The object of investigation will aim at discovering the change portal vein hemodynamics and Tei index in cirrhosis of liver and relation with child-pugh grade of hepatic function each other. On the other hand, the study will reseach for the changes in the course of proprandol treatment in cirrhosis of liver and try to understand the improvement on portal vein hemodynamics and heart function, whether or not, during proprandol treatment in hepatic cirrhosis in order that we can access to the new theoretical basis on clinical use of proprandol treatment.Methods: The investigator will select out-patient and hospitalization in patients with liver cirrhosis diagnosed 76 people, and randomly divided into control group (36 cases) and proprandol treatment group (40 cases), at the same time, select healthy volunteers (15 cases) as a healthy control group. Contral group will be given the control diet, the protention of the liver, such as conventional treatment while the treatment group will be given the proprandol treatment based on the conventional treatment. All patients with liver cirrhosis and healthy volunteers when fasting morning will be detected target portal system hemodynamics (Dpv, Dsv, Qsv, Qpv, Qsv/Qpv,et al.) and cardiac function target (LVEF, LVFS, EV/AV, Tei index, et al.)by apply of color Doppler ultrasound imaging. The control group and liver cirrhosis treatment group will be again detected the portal system hemodynamics and cardiac function target after one month.Results: 1. Dpv, Dsv, Qsv, Qsv/Qpv of Cirrhosis group are higher than healthy people, the difference is significant (P<0.05 or P<0.01), increasing its value with liver function and Child-pugh classification A, B, C class order. Vpv of Cirrhosis group are lower than healthy people, with liver function Child-pugh classification A, B, C and descending order of class. Qpv of A class cirrhosis group and B class group are significantly higher than healthy group (P<0.01), while comparison Qpv of liver function class group C and B class, Qpv group is declined (P<0.01), and lower than the healthy volunteers group.2. LA, RA diameter of Cirrhosis in patients are significantly increased than the healthy control group, there is significant difference (P<0.05); and LV, RV diameter are not change significantly (P>0.05). Compared to left ventricular wall thickness LVPWT+IVST of Cirrhosis group (20.70±2.5mm) and the healthy control group (17.91±1.9mm), there is statistically significant difference (P<0.01).3. Compared with healthy control group and A group of liver function, left class EV, AV, EV / AV are no significant difference; while EV of class B liver function, C-level Group is decreased left ventricular, AV is significantly increased (P<0.01), EV/AV ratio is significantly lower than the healthy control group, the difference is statistically significant (P<0.01). Compared with the healthy group and Child A class group, there are no significant difference on LVEF, FS, LVSV, LVEF, FS, LVSV of Child B class group are higher than healthy controls (P<0.05). Compared to Child B class, LVEF, FS, LVSV of Child C class patients are not obvious increased (P<0.05).4. Left ventricular Tei index and the IRT/ET of Cirrhosis (Child B class, Child C class) group of patients compared with healthy control group are significantly increased, the difference is significant (P<0.05); ICT/ET, compared with the healthy volunteers, is no significant difference (P>0.05). The Tei index, IRT/ET and ICT/ET of right ventricle, compared with group of in patients with cirrhosis of and normal control group, are not significant difference (P>0.05).5. LVEF, FS, LVSV, Dpv, Qpv, Dsv, Vsv, Qsv, Qsv/Qpv of Liver cirrhosis patients in treatment group after propranolol treatment of cirrhosis are decreased significantly than the control group (P<0.05 or P<0.01). EV/AV, the left ventricular Tei index, IRT/ET cirrhosis of cirrhosis treatment group is improved significantly than the control group (P<0.05).6. Portal system hemodynamics and left ventricular, such as Tei index, are significantly improved than pre-treatment in A class group and class group B after Propranolol treatment. Qpv, Qsv, Vsv, Vpv of Class C patients after Propranolol treatment are decreased than before treatment (P<0.05), there are no significant difference on Dpv, Dsv, Qsv/Qpv, LVEF, FS, EV/AV, Tei index of C class patients before and after propranolol treatment (P>0.05).7. Correlation analysis showed that: Among Qpv and EV, EV/AV, Tei index, there is no statistical significance on cirrhosis group (P>0.05). Dpv, EV/AV (r=0.46, P<0.01), and left ventricular Tei index (r=0.361, P<0.05) is related. Vpv and EV/AV (r=0.517, P<0.01), left ventricular Tei index, IRT / ET are related (r=-0.333 and -0.323, P<0.05). Splenic blood flow (Qsv) and EV, EV/AV (r are -0.31 and -0.34, P<0.05), left ventricular Tei index and IRT/ET are related (r=0.35 and 0.32, P<0.05); Qsv/Qpv with EV, EV/AV (r are -0.401 and -0.46, P <0.01) and left ventricular Tei index, IRT/ET are related (r= 0.427 and 0.39, P<0.05). Left ventricular Tei index and left ventricular Ev/Av ratio is negatively correlated (r=0.659, P<0.01), left ventricular IRT/ET and left ventricular Ev/Av ratio is negatively correlated (r=0.619, P<0.01).Conclusion: The results of this study showed that①There are an obvious hemodynamic disorders on portal system of liver cirrhosis patients, and with increasing child-pugh grade of hepatic function, exacerbating the impairment. Patients with Cirrhosis exist cardiac structural changes (LA, RA increased, LV wall thickening). Patients with advanced liver cirrhosis exist mainly overall left ventricular dysfunction and left ventricular diastolic dysfunction, and left ventricular diastolic dysfunction and the severity of the severity of liver damage is related.②The indirectly increasing ratio of Qsv/Qpv in patients with liver cirrhosis may reflect the changes on diastolic function of the patients with cirrhosis.③Propranolol therapy can be used to improve hemodynamics and global left ventricular heart function on cirrhosis patients of liver function in Child A class and B class, and have no significant effect on patients with liver cirrhosis the class of Child C.④Tei index and its associated parameters can accurately reflect changes of cardiac function on cirrhosis, and be the simple and effective diagnosis method on cirrhotic cardiomyopathy.