The Correlated Research Of Liver Dysfunction From Cardiac Insufficiency

Objective:To research the variance Liver dysfunction from cardiac insufficiency(CI) in thedifferent the United States New York Heart Association (NYHA) grading of cardiacfunction.Methods：It is a case-control study.167cases were enrolled from the first affiliated hospitalof Dalian medical college,85cases were CI patients from cardiology department,82cases were non-CI subjects from medical examination center. The age and sex of towgroups were no difference of statistics. According to NYHA grading of cardiac function,the CI patients were divided into the cardiac function II degree subgroup(n=14), thecardiac function III degree subgroup(n=41) and the cardiac function IV degreesubgroup(n=30). These were examined in enzyme linked immunosorbent assay thatincluded the alanine transarninase(ALT）, glutamic-oxalacetic transaminase(AST）,albumin(ALB), globulin(GLB）, total protein(TP), albumin and globulin ratio(A/G),gamma glutamyl transpeptidase(r-GT), alkaline phosphatase(ALP), cholinesterase(CHE), total bilirubin(T-BIL,direct bilirubin(D-BIL). At the same time the bloodplatelet count(PLT) and makro-platelet percentage(P-LCR) were measured. enchresearch subject underwent the echocardiography to obtain the left ventricularend-diameter(LVEDD）and left ventricular ejection fraction(LVEF）. The age, gender,case history and physical examination were collected by refering to the documents. Bythe application of SPSS11.5, the data base was setted up, the statistical analysis wasproceeded, the variability was comparised, Pearson and Spearman linear correlationalanalysis were carried out. Results：1.In CI group the γ-GT（65.33±51.91IU/L），CHE（5870.59±3209.81U/L），T-BIL（25.36±16.16mmol/L），D-BIL（8.69±6.51mmol/L）and P-LCR（32.42±9.71%）was higher than that in the normal control group（the γ-GT33.88±47.87IU/L，CHE9434.42±1622.87U/L，T-BIL16.15±5.11mmol/L，D-BIL4.21±1.67mmol/L，P-LCR28.76±8.06%, P＜0.01）； In CI group the LVEF （37.22±11.66%）， ALB（39.79±4.99g/L）, Glob （24.71±5.16g/L）, TP （64.48±7.85g/L） and PlT（181.19±54.30×109/L） was lower than that in normal control group（LVEF60.12±0.58%, ALB46.85±2.15g/L, Glob29.76±3.64g/L, TP76.00±4.40g/L,PlT205.86±45.60×109/L， P＜0.01）；Non-statistics differences were founded betweenCI group(the ALT30.42±24.04IU/L, AST30.06±12.71IU/L, ALP82.91±32.37IU/L,A/G1.66±0.40）and normal control group(ALT25.21±13.05IU/L, AST25.28±13.05IU/L, ALP72.09±17.41IU/L, A/G1.60±0.21, P＞0.05).2.Among the comparisons of cardiac function II、III、IV degree subgroups, non-statistics differences were founded at the gender, Classification of CI and case numbersof CI protopathy(P＞0.05).3.Among the group comparisons of each CI subgroup and normal control group,statistics differences were founded at LVEDD（cardiac function II degree subgroup55.93±5.34mm, cardiac function III degree subgroup57.68±8.64mm and cardiacfunction IV degree subgroup63.50±11.99mm）, LVEF(cardiac function II degreesubgroup45.64±9.68%, cardiac function III degree subgroup36.71±9.73%and cardiacfunction IV degree subgroup34.00±13.25%）, ALT(cardiac function II degree subgroup25.22±14.88IU/L, cardiac function III degree subgroup30.40±15.26IU/L and cardiacfunction IV degree subgroup32.30±33.42IU/L）, AST（cardiac function II degreesubgroup25.56±11.37IU/L, cardiac function III degree subgroup30.41±13.07IU/Land cardiac function IV degree subgroup34.07±11.34IU/L）, ALP（cardiac function IIdegree subgroup82.07±18.98IU/L, cardiac function III degree subgroup88.05±25.20IU/L and cardiac function IV degree subgroup89.93±43.74IU/L）,γ-GT(cardiac function II degree subgroup84.00±53.89IU/L, cardiac function III degreesubgroup86.93±36.40IU/L and cardiac function IV degree subgroup88.10±66.33IU/L）, ALB(cardiac function II degree subgroup41.78±5.69g/L, cardiac function IIIdegree subgroup40.59±4.42g/L and cardiac function IV degree subgroup37.77±4.85g/L）, GLB（cardiac function II degree subgroup23.57±3.20g/L, cardiac function IIIdegree subgroup24.98±5.54g/L and cardiac function IV degree subgroup 24.88±5.42g/L）, TP（cardiac function II degree subgroup65.25±7.58g/L, cardiacfunction III degree subgroup65.50±8.26g/L and cardiac function IV degree subgroup62.72±7.34g/L）, CHE(cardiac function II degree subgroup5695.86±3200.52U/L,cardiac function III degree subgroup5262.42±3319.07U/L and cardiac function IVdegree subgroup5103.30±2957.28U/L）, T-BIL(cardiac function II degreesubgroup21.81±9.35mmol/L, cardiac function III degree subgroup25.41±18.40mmol/L and cardiac function IV degree subgroup26.95±15.55mmol/L）,D-BIL(cardiac function II degree subgroup6.98±3.27mmol/L, cardiac function IIIdegree subgroup8.25±5.91mmol/L and cardiac function IV degreesubgroup10.07±8.10mmol/L）, PLT （cardiac function II degree subgroup169.27±31.05×109/L, cardiac function III degree subgroup184.29±52.83×109/L andcardiac function IV degree subgroup186.61±56.54×109/L）and P-LCR(cardiac functionII degree subgroup37.41±7.97%, cardiac function III degree subgroup35.12±7.0%andcardiac function IV degree subgroup28.03±8.98%）（P＜0.05或P＜0.01）；Non-statistics differences were founded at the A/G(cardiac function II degree subgroup1.80±0.32, cardiac function III degree subgroup1.65±0.37and cardiac function IVdegree subgroup1.60±0.43）and age(P>0.05).4.The index changed in the process of heart function aggravation: LVEDDgradually enlarged and LVEF progressive decreased； ALT and AST graduallyheightened and were the most significant at cardiac function IV degree；ALP andγ-GTgradually heightened，γ-GT was the most significant at cardiac function II degree，ALPwas the most significant at cardiac function IV degree；ALB gradually decreased andwas the most significant at cardiac function IV degree；CHE gradually decreased andwas the most significant at cardiac function II degree；The serum bilirubin graduallyheightened, T-BIL was the most significant at cardiac function III degree；P-LCRmarkedly heightened at cardiac function II degree and markedly cutted down at cardiacfunction IV degree；PLT gradually decreased and was the most significant at cardiacfunction II degree.5.The LVEF is negative correlated with LVEDD, AST, γ-GT, T-BIL, D-BIL,P-LCR. The LVEF is positive correlation with ALB, GLB, TP, CHE, PLT.Conclusions：1.It cues the aggravation of hepatocellular injury at CI advanced stage, which isthe level of serum transaminase gradually heightenes and the most significant at cardiacfunction IV degree. It might be early predictional index of CI secondary cholangioles injury, which is the level of serum gamma glutamyl transpeptidase significantlyheightenes at cardiac function II degree. It might be early predictional index of liversynthesis miopragia, which is the level of serum cholinesterase gradually decreases atCI prophase.2.It cues the development of bilirubin dysbolismus at CI advanced stage, which isthe level of serum bilirubin gradually heightenes. It cues the development ofhypoproteinemia at CI advanced stage, which is the level of serum albumin graduallydecreases.3.It might be early predictional index of CI hypercoagulable states, which is thelevel of makro-platelet percentage significantly heightenes at CI prophase.