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中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (03) : 278 -282. doi: 10.3877/cma.j.issn.2095-3232.2022.03.013

临床研究

肝移植相关性应激性心肌病临床特征和诊治
赵渊宇1, 毛家玺1, 傅宏1, 刘聪1, 郭闻渊1, 滕飞1,()   
  1. 1. 200003 上海,海军军医大学附属长征医院肝脏外科
  • 收稿日期:2022-02-09 出版日期:2022-06-10
  • 通信作者: 滕飞
  • 基金资助:
    国家自然科学基金面上项目(81971503); 国家自然科学基金青年项目(81702923); 上海市科学技术委员会科研计划项目(18ZR1439300); 长征医院军事医学科研专项(2019CZJS222)

Clinical characteristics, diagnosis and treatments of Takotsubo cardiomyopathy after liver transplantation

Yuanyu Zhao1, Jiaxi Mao1, Hong Fu1, Cong Liu1, Wenyuan Guo1, Fei Teng1,()   

  1. 1. Department of Hepatobiliary Surgery, Shanghai Changzheng Hospital Affiliated to Naval Medical University, Shanghai 200003, China
  • Received:2022-02-09 Published:2022-06-10
  • Corresponding author: Fei Teng
引用本文:

赵渊宇, 毛家玺, 傅宏, 刘聪, 郭闻渊, 滕飞. 肝移植相关性应激性心肌病临床特征和诊治[J/OL]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 278-282.

Yuanyu Zhao, Jiaxi Mao, Hong Fu, Cong Liu, Wenyuan Guo, Fei Teng. Clinical characteristics, diagnosis and treatments of Takotsubo cardiomyopathy after liver transplantation[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(03): 278-282.

目的

探讨肝移植相关性应激性心肌病(Takotsubo cardiomyopathy,TC)的临床表现和诊疗经验。

方法

收集PubMed、Medline、Embase、万方、中国知网、维普数据库中已发表的肝移植相关性TC文献资料。文献发表时间截止至2021年4月30日。中文检索式:"((应激性心肌病)或(Takotsubo心肌病)或(左心室心尖球囊综合征)或(心碎综合症))和(肝移植)"。英文检索式:"((Takotsubo cardiomyopathy) or (Takotsubo syndrome)) and ((liver transplantation) or (liver transplant))"。分析患者的一般资料、临床特征及诊治情况。

结果

纳入22篇文献,共59例患者。其中男30例,女29例;平均年龄(56±10)岁。TC主要表现为胸痛、呼吸困难、少尿、心跳骤停等。31例发生TC中位时间为术后1(0~201)d。心功能检查表现为左心室射血分数明显降低,心肌酶谱指标升高,心电图异常表现为ST段抬高和(或)T波倒置等,无梗阻性冠状动脉病变。紧急治疗主要包括心肺复苏、血流动力学药物的应用和(或)主动脉内球囊反搏。29例心功能恢复,心功能恢复时间为18(2~180)d。6例死亡,死亡率17%(6/35)。

结论

TC是一类较罕见的肝移植相关性疾病。尽早复苏、合理应用血流动力学药物和(或)主动脉内球囊反搏有望改善预后。

Objective

To investigate the clinical characteristics, diagnosis and treatment experience of Takotsubo cardiomyopathy (TC) after liver transplantation.

Methods

Literature of liver-transplantation-associated TC, published before April 30, 2021, were retrieved in PubMed, Medline, Embase, Wanfang Data, CNKI and Chongqing VIP databases. The search terms in Chinese were "((stress cardiomyopathy) or (Takotsubo cardiomyopathy) or (left ventricular apical balloon syndrome) or (Takotsubo syndrome)) and (liver transplantation)", and the English ones were "((Takotsubo cardiomyopathy) or (Takotsubo syndrome)) and ((liver transplantation) or (liver transplant))". The baseline data, clinical characteristics, diagnosis and treatment were analyzed.

Results

22 articles consisting of 59 patients were included. Among them, 30 patients were male and 29 female, aged (56±10) years on average. The manifestations of TC were mainly chest pain, dyspnea, oliguria and cardiac arrest, etc. The median onset time of TC in 31 cases was postoperative 1(0-201) d. Cardiac function examination revealed that left ventricular ejection fraction was significantly decreased and myocardial enzyme spectrum indexes were increased. ECG abnormality were ST segment elevation and/or T wave inversion, and no obstructive coronary artery disease was observed. Emergency treatments consisted of cardiopulmonary resuscitation, use of hemodynamic drugs and/or intra-aortic balloon counterpulsation. Heart function was recovered in 29 cases, and the time of heart function recovery was 18(2-180) d. 6 cases died with a mortality of 17%(6/35).

Conclusions

TC is a rare disease associated with liver transplantation. Prompt resuscitation, rational use of hemodynamic drugs and/or intra-aortic balloon counterpulsation are potential approaches to improve clinical prognosis.

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