The Effects Of Liver Function, Cardiovascular Disease And Endothelial Progenitor Cells In Decompensated Cirrhosis

Part One Cardiac remodeling and Myocardial mechanical properties in patients with decompensated CirrhosisObjective: The heart structure,function and hemodynamic changes of patients with decompensated liver cirrhosis were compared.Methods: From February 2016 to August 2017,Liver Cirrhosis patients were enrolled from the North Sichuan Medical College Affiliated Hospital,aged from 43 to 78 years(mean age 63.4±48.8 years).Among 66 cases of patients which 52 were men,female in 14 cases,Standard 12-lead ECG,at the same time,Observe and record the frequency of arrhythmias and record heart rate.selected 23 cases of normal person of similar age.Excluding the following disease such as coronary heart disease,hypertension,diabetes,congenital cardiovascular disease,valvular heart disease,anemia heart disease,myocarditis,alcoholic cardiomyopathy or local cardiomyopathy(for example keshan disease,severe renal insufficiency and severe lung diseaseanalyzes.Cardiac related paramenters were determined by echocardiography,such as using two-dimensional speckle tracking imaging,acquisition Overall myocardial strain,heart ventricular size,wall thickness,cardiac systolic and diastolic function parameters,comprehensive evaluation cirrhosis and cardiac structure,function and characteristic of conventional biochemical index changes.Echocardiographic technique is applied to left ventricle long axis section.,apex four chamber,two chamber,three chamber and left ventricular mitral level,level of papillary muscle and apex short axis views acquisition cardiac ventricular size,wall thickness,cardiac systolic and diastolic function ?hemodynamic parametersand and use the two-dimensional speckle tracking imaging technologyeach to compared segment of the left ventricle wall peak systolic strain and peak time of strain.Such as to get a 3-5 dynamic image of the cardiac cycle,every parameter was compared.Storage ?analysis and evaluated the heart structure and function and hemodynamic changes in patients with cirrhosis.Results: Compared with control group,patients with cirrhosis had per minute output(CO),left atrial diameter(LAD),aortic blood flow velocity(AV),left ventricle myocardial performance index(LV-Tei),mitral inflow the peak end filling velocities(MVA)increase compared with healthy controls(Pall < 0.05),left ventricular ejection fraction(EF),early diastolic mitral annulus velocity(e),interventricular septum thickness(IVSTs)decrease than control,mitral inflow the peak early filling velocities(MVE)/e more increase than healthy controls(Pall < 0.05),tricuspid inflow the peak early filling velocities(TVE),tricuspid inflow the peak end filling velocitie(TVA)and right ventricular myocardial performance index(RV-Tei)speed increase than normal control group(Pall < 0.05),the area rate of right ventricular(FAC),tricuspid annular plane systolic excursion(TAPSE)decrease compared with healthy controls(Pall < 0.05),at the same time compared with the control group in patients,it is concluded that,between the two groups there is no difference statistically significant about the incidence of arrhythmia,also no difference among the interventricular septum thickness(IVSTd),left ventricular diastolic late diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular posterior end-diastolic back wall thickness(LVPWTd),Left ventricular isovolumetric contraction,diastolic time(LV-IVRT,LV-IVCT),right ventricular isometric contraction,diastolic time(RV-IVRT,RV-IVCT),MVE?MVE/A,left and right ventricular outflow tract(LVOT,RVOT)inside diameter,TVE/A,right ventricular anterior wall thickness(RVAWd),end-diastolic pulmonary artery diameter(PAD)all have no statistically significant difference compared with control(P all > 0.05).Compared with healthy controls,patients with decompensated cirrhosis group left ventricular myocardial whole circumferential strain(GLPS CSmax)and radial peak strain(GLPS-RSmax),long axis strain stress(GLPS-LSmax)increase(P < 0.05),and circumferential strain of segmental analysis on three segmental of LV inferior wall myocardial(AP-inf-SCmax,MV-inf-SCmax,PW-inf-SCmax),basal segmental(MV-antsept-SCmax,MV-sept-SCmax),middle section of the wall(PW-post-SCmax)markedly increased than the control group(Pall < 0.05),others segmental myocardial peak strain has no statistically significant difference(P > 0.05),The radial strain and long axial segmental strain analysis showed that there was no statistical difference between two groups(Pall >0.05).Left ventricular movement synchronization statistical analysis to obtain: the peak time of radial straint on left ventricular myocardial middle segment and apex section of the postior wall(PW-post-RTmax,AP-post-RTmax),apex laterar section wall(AP-Lat-RTmax),papillary muscle level inferior wall(PW-inf-RTmax)movement out of sync and ahead of normal control group.long axis strain :the interval movement(TmaxAPantsept-SL).Tmax MV antsept-SL,TmaxMV-sept-SL,TmaxPW-antsept-SL),the apex section of the postior wall(TmaxAP-post-SL),basal segment antior and inferior wall,and postior wall(TmaxMV-ant-SL,TmaxMV-post-SL,TmaxMV-inf-SL),the middle section of the level about inferior wall(TmaxPW-inf-SL)movement synchronization poor(Pall < 0.05).Conclusions: In patients with decompensated cirrhosis the cardiac remodeling,cardiac function and aortic blood speed increase,left ventricular diastolic function is impaired,left ventricular myocardial overall stress increases,the segmental left ventricular myocardial circumferential stress increase,long axis section strain and radial strain stress has no obvious differences,but the segmental movement out of sync.Part Two Discuss the Endothelial progenitor cells' variation in patients with CirrhosisObjective: Investigate the correlation among liver function,the structure ? function and hemodynamics of the cardiac and endothelial progenitor cells(EPCs)in cirrhotic patients.Methods: From February 2016 to August 2017,Liver Cirrhosis patients were enrolled from the North Sichuan Medical College Affiliated Hospital,aged from 43 to 78 years(mean age 46.3±8.82 years),measure the height,weight,blood pressure,and calculate the waist to hip ratio.Among 66 cases of patients which 52 were men,female in 14 cases.Excluding the following disease such as coronary heart disease,hypertension,diabetes,congenital cardiovascular disease,valvular heart disease,anemia heart disease,myocarditis,alcoholic cardiomyopathy or local cardiomyopathy,severe renal insufficiency and severe lung diseaseanalyzes.Standard 12-lead ECG,at the same time,selected 23 normal similar age person as a contrast.At the same time collected including routine biochemical,electrolyte,liver function,blood gas analysis(ABG)index for two groups:AST?ALT?Ch E?ADA?WBC?RBC?LYI%?ALB?A/G?Pa CO2?BE?AB?K+?Na+ and so on.Next gather blood(PB)300?l/per.divided into three tube(100?l per tube),A tube for IG(CD3 +,CD4 +)as contrast,B tube for IG(CD3 +?CD4 +?CD133 +?KDR),C tube for IG(CD3 +?CD4 +?CD34 +?KDR)by Flow Cytommetry,(FCM)to detect the number of three subgroups of EPCs(CD34 +,CD133 +,KDR+)subgroup of EPCs in lymphocytes,analyzed in the form of logarithmic conversion(Log),finally use the BD company FACSCanto II instrument fluorescence activated cell analysis.At the same time,we used the echocardiography to obtain cardiac atrioventricular size,ventricular wall thickness and cardiac function parameters(see the part one),and comprehensively evaluated the correlation among liver function,EPCs and cardiac function in patients with decompensated cirrhosis.Results: 1)The study found: AST?ALP?GGT?TBIL?TBA?DBIL?IBIL?Cys C?GLOB?ADA was increased in the case group(all P < 0.05),WBC?RBC?PLT?LYI(%)?Ch E?ALB?PH significantly decreased(P < 0.05).ABG fund SB?AB?Anion gap was increased compared with normal control group,Pa CO2?Pa O2?Sa O2(%)decreased(P all<0.05).2)The cell number of Log KDR+EPCs ? Log CD34+EPCs decreased,Log CD133+EPCs incresered(P all<0.05).3)The statistical analysis of cardiac function and myocardial mechanics in the first part.The results of the correlation analysis: Log KDR+EPCs with ADA,LYI% and GLOB express positively correlated,and negatively correlated with Urea(P all<0.05).Log CD34+EPCs with Lact showed negatively correlated and straightly correlated with LYI%(P all<0.05).The study of cardiac function and myocardial showed that Log CD133+EPCs was negatively correlated with left ventricular diastolic function E/e(P<0.05).Further discovery,MVE,MVA,LV-tei with GLOB,ADA,RBC expressed positively correlation,(P all<0.05),RV-FAC was positively related with bile acid and bilirubin,negatively correlated with TAPSE and Ch E(P all<0.05);Tr E,Tr A positively correlated with Urea,Crea,Cys C,RV-tei was negatively correlated with bile acid and bilirubin(P all<0.05).Myocardial showed that GLPS-RS was positively correlated with ALT,and GLPS-CS with AST was positively correlated(P all<0.05).Conclusions: In patients with decompensated cirrhosis of liver function,heart function,EPCs are indispensable complement each other,liver function damage caused the hyperdynamic circulatory system,blood volume distribution of normal neurohumoral system disorders,acid-base imbalance,which will lead to blood cell damage.On the one hand,stimulated EPCs to repair damaged tissue and proliferation of new blood vessels,on the other hand,due to the impaired liver function with the hemodynamic changes,decreased heart function,myocardial remodeling,strain changed.