M. Abrahamovych, M. Farmaha
Danylo Halytsky Lviv National Medical University
Introduction. Syntropic comorbid disorders of the circulatory system in patients with liver cirrhosis are among the most common ones and include two separate diseases: cardiomyopathy with characteristic changes of the heart structure and function; and stable arterial hypotension with its characteristic features of daily blood pressure rhythm and variability, diagnostics of which requires special investigations: echocardiography using doppler, 24-hour blood pressure monitoring, etc.
Aim: to distinguish the clinical markers of cardiomyopathy and stable arterial hypotension according to the results of the primary examination of patients with liver cirrhosis.
Methods and materials. Complex clinical laboratory and instrumental examination of 603 patients with liver cirrhosis (445 men and 158 women, average age 49.2 ± 10.6 years) was conducted. We distinguished 490 (81.3 %) patients with extrahepatic lesions of the blood circulation system (experimental group that was divided into three subgroups: with syntropic cardiomyopathy separately (103 patients), with syntropic arterial hypotension (89 patients), other (306 patients)), as well as 113 patients (18.7 %) without blood circulation system lesions (comparison group (CG)).
The study is dedicated to the statistical analysis with calculation of the chances to put the correct diagnosis of syntropic damages of the blood circulation system using separate indicator: a marker. The research was carried out in four consecutive steps, which included assessment of demographic information, patient complaints, anamnesis and objective review findings.
The actual material was processed in the MS Excel and SPSS based on the conjugation tables. The relationships between cardiomyopathy (or arterial hypotension) and the investigated marker were considered to be confirmed, if the modulus of the association coefficient exceeded 0.5 (or 0.3 for the contiguous factor).
Results and discussion. According to the first step consisting in the analysis of information from the passport, it was found that gender does not indicate the presence of a syntropic damages of the blood circulation system, unlike the age which can reliably indicate cardiomyopathy (middle and old age) or arterial hypotension (young and mature age). Among the complaints of patients with liver cirrhosis (second task), the pain on the left reliably denies the diagnosis of cardiomyopathy and indicates the presence of arterial hypotension, nausea clearly indicates that the patient does not have stable arterial hypotension. Due to the analysis of the anamnesis of patients with liver cirrhosis (third task),it was revealed that the presence of C-viral cirrhosis (viral etiology) or combined B- and C-viral cirrhosis (viral etiology) in patients can reliably deny the diagnosis of cardiomyopathy, and the presence of cirrhosis lasting for more than three years, bleedings from varicose veins of the esophagus and/or the presence of virus B-cirrhosis of viral etiology independently of each other can reliably indicate that the patient has stable arterial hypotension. According to the results we received from the fourth step of the research, normal or lower normal body mass index, icteric skin and sclera, weakened heart sounds are associated with cardiomyopathy, and edema on the lower extremities and “caput medusae” – with its absence. Telangiectasias, ascites, “caput medusae”, edema on the lower extremities, hepato- and splenomegaly indicate a stable arterial hypotension.
Conclusions. The analysis allows us to confirm that middle and old aged patients have complaints on pain and/or heaviness in the left hypochondrium, if C- or C- and B-viral etiologies of the cirrhosis are absent, body mass index is normal or lower than norm, icteric skin and sclera, weakened heart sounds and “caput medusae” as well as edema on the lower extremities are absent, the presence of cardiomyopathy may be presumed; and in young or middle aged patients there are complaints on pain in the left hypochondrium, nausea, if liver cirrhosis lasts longer than three years, there is information of esophageal varicose veins’ bleedings in anamnesis of the patient, B- viral cirrhosis, telangiectasias, ascites, “caput medusae”, edema on the lower extremities, hepato- and splenomegaly, the presence of the stable arterial hypotension may be presumed. Taking into account clinical markers during examination of the patients with liver cirrhosis makes it possible to form risk groups concerning presence of the corresponding syntropic comorbid blood circulation system damages, examine the patient correctly and determine the correct treatment strategy.
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