Research advances in cirrhotic cardiomyopathy
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摘要: 肝性心肌病是指肝硬化患者的心脏结构和功能出现异常。其发病机制涉及心肌细胞的凋亡,β受体功能受损,一氧化氮、一氧化碳、内源性大麻素、细菌内毒素、炎症介质等心脏抑制因子的增多等。目前尚无统一的诊断标准,可以结合临床表现、B型利钠肽、N端利钠肽前体、心电图、超声、心脏磁共振等检查做出临床诊断。治疗上主要是在控制肝硬化的基础上给予保护心肌的治疗,适时肝移植可能是最佳治疗方法。Abstract: Cirrhotic cardiomyopathy( CCM) refers to the abnormalities in cardiac structure and function in patients with liver cirrhosis. The pathogenesis of CCM involves the apoptosis of cardiomyocytes,impaired β- receptors,and increased levels of cardiodepressant factors such as nitric oxide,carbon monoxide,endocannabinoids,bacterial endotoxins,and inflammatory mediators. At present,there are no unified diagnostic criteria for CCM,and a clinical diagnosis can be made based on clinical manifestation,plasma brain natriuretic peptide,N- terminal pro- brain natriuretic peptide,electrocardiographic findings,ultrasound findings,and the results of cardiac magnetic resonance imaging. The treatment of CCM involves controlling liver cirrhosis and protecting the myocardium,and the best therapeutic method is liver transplantation at the right time.
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Key words:
- cardiomyopathies /
- liver cirrhosis /
- diagnosis /
- treatment /
- review
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[1]RUIZ-DEL-ARBOL L,SERRADILLA R.Cirrhotic cardiomyopathy[J].World J Gastroenterol,2015,21(41):11502-11521. [2]BAIK SK,FOUAD TR,LEE SS.Cirrhotic cardiomyopathy[J].Orphanet J Rare Dis,2007,2:15. [3]CHEN X,ZHANG X,KUBO H,et al.Ca2+influx-induced sarcoplasmic reticulum Ca2+overload causes mitochondrial-dependent apoptosis in ventricular myocytes[J].Circ Res,2005,97(10):1009-1017. [4]NAM SW,LIU H,WONG JZ,et al.Cardiomyocyte apoptosis contributes to pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated mice[J].Clinical Science,2014,127(8):519-526. [5]GERBES AL,REMIEN J,JUNGST D,et al.Evidence for down-regulation of beta-2-adrenoceptors in cirrhotic patients with severe ascites[J].Lancet,1986,1(8495):1409-1411. [6]KAKIMOTO H,IMAI Y,KAWATA S,et al.Altered lipid composition and differential changes in activities of membrane-bound enzymes of erythrocytes in hepatic cirrhosis[J].Metabolism,1995,44(7):825-832. [7]GASSANOV N,CAGLAYAN E,SEMMO N,et al.Cirrhotic cardiomyopathy:a cardiologist's perspective[J].World J Gastroenterol,2014,20(42):15492-15498. [8]LIU H,SONG D,LEE SS.Role of heme oxygenase-carbon monoxide pathway in pathogenesis of cirrhotic cardiomyopathy in the rat[J].Am J Physiol Gastrointest Liver Physiol,2001,280(1):g68-g74. [9]BALDASSARRE M,GIANNONE FA,NAPOLI L,et al.The endocannabinoid system in advanced liver cirrhosis:pathophysiological implication and future perspectives[J].Liver Int,2013,33(9):1298-1308. [10]GASKARI SA,LIU H,MOEZI L,et al.Role of endocannabinoids in the pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated rats[J].Br J Pharmacol,2005,146(3):315-323. [11]WIEST R,LAWSON M,GEUKING M.Pathological bacterial translocation in liver cirrhosis[J].J Hepatol,2014,60(1):197-209. [12]TAKEUCHI O,AKIRA S.PATTERN recognition receptors and inflammation[J].Cell,2010,140(6):805-820. [13]DIMITRIOS S,VLACHOGIANNAKOS J,ANASTASIADIS G,et al.Frequency and severity of cirrhotic cardiomyopathy and its possible relationship with bacterial endotoxemia[J].Dig Dis Sci,2013,58(10):3029-3036. [14]WEHMEYER MH,HEUER AJ,BENTEN D,et al.High rate of cardiac abnormalities in a postmortem analysis of patients suffering from liver cirrhosis[J].J Clin Gastroenterol,2015,49(10):866-872. [15]WRON'SKI J,FIEDOR P,KWOLCZAK M,et al.Retrospective analysis of liver cirrhosis influence on heart walls thickness[J].Pathol Res Pract,2015,211(2):145-149. [16]TAN K,ZHANG PN,WANG TC.Pathologic changes in cirrhotic myocardium[J].J Wuhan Univ Sci Tech:Nat Sci Edit,2005,28(4):413-414.(in Chinese)谭凯,张鹏宁,王天才.肝硬化大鼠心肌病理研究[J].武汉科技大学学报:自然科学版,2005,28(4):413-414. [17]LIPPI G,FAVALORO EJ,MONTAGNANA,et al.Prevalence of hypokalaemia:the experience of large academic hospital[J].Intern Med J,2010,40(4):315-316. [18]HANSEN S,MOILER S,BCNDTSEN F,et al.Diurnal variation and dispersion in QT interval in cirrhosis relation to haemodynamic changes[J].J Hepatol,2007,47(3):373-380. [19]PIETRASIK G,ZAREBA W.QRS fragmentation:diagnostic and prognostic significance[J].Cardiol J,2012,19(2):114-121. [20]SAMPAIO F,PIMENTA J,BETTENCOURT N,et al.Systolic and diastolic dysfunction in cirrhosis:a tissue-doppler and speckle tracking echocardiography study[J].Liver Int,2013,33(8):1158-1165. [21] KAZANKOV K,HOLLAND-FISCHER P,ANDERSEN NH,et al.Resting myocardial dysfunction in cirrhosis quantified by tissue doppler imaging[J].Liver Int,2011,31(4):534-540. [22]XU H,YANG XY,WU XL,et al.Quantitative assessment of left ventricular volume and systolic function using real-time three-dimensional chocardiography in late-stage liver cirrhosis[J].J Chin Clin Med Imaging,2007,18(4):262-264.(in Chinese)徐卉,杨晓英,吴晓丽,等.实时三维超声心动图对中晚期肝硬化患者左心室容积及收缩功能的评价[J].中国临床医学影像杂志,2007,18(4):262-264. [23]LOSSNITZER D,STEEN H,ZAHN A,et al.Myocardial late gadolinium enhancement cardiovascular magnetic resonance in patients with cirrhosis[J].J Cardiovasc Magn Reson,2010,12:47. [24]SAMPAIO F,LAMATA P,BETTENCOURT N,et al.Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy[J].J Cardiovasc Magn Reson,2015,17(1):61. [25]CHAYANUPATKUL M,LIANGPUNSAKUL S.Cirrhotic cardiomyopathy:review of pathophysiology and treatment[J].Hepatol Int,2014,8(3):308-315. [26]HENRIKSEN JH,BENDTSEN F,HANSEN EF,et al.Acute non-selective beta-adrenergic blockade reduces prolonged frequency-adjusted Q-T interval(QTc)in patients with cirrhosis[J].J Hepatol,2004,40(2):239-246. [27]WONG F,SALERNO F.Beta-blockers in cirrhosis:friend and foe?[J].Hepatology,2010,52(3):811-813. [28]SERSTET,MELOT C,FRANCOZ C,et al.Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites[J].Hepatology,2010,52(3):1017-1022. [29]WONG KY,WONG SY,MCSWIGGAN S,et al.Myocardial fibrosis and QTc are reduced following treatment with spironolactone or amiloride in stroke survivors:a randomised placebo-controlled cross-over trial[J].Int J Cardiol,2013,168(3):5229-5233. [30]ABBASI A,JOHARIMOQADDAM A,FARAMARZI N,et al.Opioid receptors blockade modulates apoptosis in a rat model of cirrhotic cardiomyopathy[J].Ann Med Health Sci Res,2014,4(3):404-409. [31]LIU L,LIU H,NAM SW,et al.Protective effects of erythropoietin on cirrhotic cardiomyopathy in rats[J].Dig Liver Dis,2012,44(12):1012-1017. [32]YANG CH,TING WJ,PAI PY,et al.Anti-apoptosis effects on hearts of SHSST cyclodextrin complex in a carbon tetrachloride-induced cirrhotic cardiomyopathy rat model[J].Chin J Physiol,2015,58(1):38-45. [33]SAMPATHKUMAR P,LERMAN A,KIM BY,et al.Post-liver transplantation myocardial dysfunction[J].Liver Transpl Surg,1998,4(5):399-403.
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