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肝移植术后Takotsubo综合征的诊治及文献复习

康一生, 李丹阳, 于立新, 等. 肝移植术后Takotsubo综合征的诊治及文献复习[J]. 器官移植, 2022, 13(5): 640-646. doi: 10.3969/j.issn.1674-7445.2022.05.014
引用本文: 康一生, 李丹阳, 于立新, 等. 肝移植术后Takotsubo综合征的诊治及文献复习[J]. 器官移植, 2022, 13(5): 640-646. doi: 10.3969/j.issn.1674-7445.2022.05.014
Kang Yisheng, Li Danyang, Yu Lixin, et al. Diagnosis and treatment of Takotsubo syndrome after liver transplantation and literature review[J]. ORGAN TRANSPLANTATION, 2022, 13(5): 640-646. doi: 10.3969/j.issn.1674-7445.2022.05.014
Citation: Kang Yisheng, Li Danyang, Yu Lixin, et al. Diagnosis and treatment of Takotsubo syndrome after liver transplantation and literature review[J]. ORGAN TRANSPLANTATION, 2022, 13(5): 640-646. doi: 10.3969/j.issn.1674-7445.2022.05.014

肝移植术后Takotsubo综合征的诊治及文献复习

doi: 10.3969/j.issn.1674-7445.2022.05.014
基金项目: 

国家自然科学基金面上项目 81870444

详细信息
    作者简介:
    通讯作者:

    刘懿禾,学士,主任医师,研究方向为移植重症,Email:13902011113@163.com

  • 中图分类号: R617, R541

Diagnosis and treatment of Takotsubo syndrome after liver transplantation and literature review

More Information
  • 摘要:   目的  总结肝移植术后Takotsubo综合征(TTS)的诊疗经验。  方法  回顾性分析1例肝移植术后TTS患者的临床资料,总结其临床特点、诊断方法及治疗策略,并进行文献复习。  结果  1例43岁女性患者,因原发性胆汁性肝硬化8年行劈离式肝移植,手术过程顺利。术后3 d患者出现焦虑、烦躁、呼吸困难以及定向力障碍,低血压,氨基末端脑钠肽前体(NT-proBNP) > 35 000 pg/mL,肌酸激酶同工酶(CK-MB)5.9 U/L,肌钙蛋白I(TnI)1.78 μg/L。心电图提示窦性心律,超声心动图提示左心室壁运动弥漫减弱及心尖部球形扩张,并伴有二尖瓣、三尖瓣中~重度反流,左心室射血分数(LVEF)下降至23%,但未见心室壁节段性运动异常或对应的心电图改变,不考虑急性冠状动脉综合征。InterTAK诊断评分为73分,考虑肝移植术后TTS,给予美托洛尔、辅酶Q10、重组人脑利钠肽、去乙酰毛花苷及劳拉西泮等治疗。术后10 d复查超声心动图,左心功能明显改善,LVEF恢复至50%。术后40 d患者出院,移植肝功能恢复良好,随访期间继续服用美托洛尔至投稿日,未再复发。  结论  肝移植术后TTS的发生较罕见,诊断上存在困难,但病情严重及预后较差,需要早期识别和及早干预。

     

  • 图  1  本例TTS患者的心电图表现

    注:A图为肝移植术前心电图,窦性心律,无明显ST-T异常;B图为术后3 d心电图,提示窦性心动过速,前壁及下壁导联ST段压低及其他导联T波低平。

    Figure  1.  Electrocardiogram findings of this TTS patient

    图  2  本例TTS患者超声心动图表现

    Figure  2.  Echocardiographic findings of this TTS patient

    图  3  本例TTS患者心肌酶学动态变化

    注:患者于术后4 d确诊TTS(黑色箭头),经治疗后于术后10 d恢复(橙色箭头)。

    Figure  3.  Dynamic changes of myocardial enzymology of this TTS patient

    表  1  文献报道的肝移植术后TTS

    Table  1.   TTS after liver transplantation in literature

    作者 年份 国家 例数(n 原发病 发生时间 最低LVEF(%) 机械辅助 分型 结局
    Lee HR, et al[2] 2007 美国 1 NASH合并肝癌 术后1 d - 心尖型 -
    Phillips MS, et al[4] 2008 美国 1 原发性硬化性胆管炎 术后10 d 20 心尖型 好转出院
    Saner FH, et al[5] 2010 德国 2 乙肝肝硬化、丙肝肝硬化 术后5 d 20 心尖型 1例术后2 d死亡,1例好转
    Anders MM, et al[6] 2011 巴西 1 ALC 术后2 d 9 IABP 心尖型 好转出院
    Tachotti Pires LJ, et al[7] 2012 巴西 1 PBC 术后4 d 25 局灶型 好转出院
    Bedanova H, et al[8] 2013 捷克 1 自身免疫性肝炎 术后2 d 20 IABP 心尖型 心功能未完全恢复,术后30 d出院
    Vachiat A, et al[9] 2016 南非 1 丙肝肝硬化及ALC - 23 LVAD 心尖型 好转出院
    Aniskevich S, et al[3] 2017 美国 24 ALC 8例、丙肝肝硬化5例、NASH 5例、隐源性肝硬化3例、PBC 1例、自身免疫性肝炎1例、多囊肝1例,4例合并肝癌 术后3(0~27)d 27(15~35) - 均存在弥漫性运动减弱或无运动 2例分别在术后63 d和145 d死亡,其余好转出院
    Biondi RS, et al[10] 2017 巴西 1 隐源性肝硬化 术后2 d 12 ECMO 心尖型 好转出院
    Reddy RV, et al[11] 2018 印度 1 乙肝肝硬化 术后1 d 25 IABP 局灶型 好转出院
    Galván NT, et al[12] 2018 美国 6 ALC,2例合并丙肝及肝癌 5例在术后2 d内,1例在术后7 d 10~35 IABP 3例,VAD 2例 仅1例为典型心尖型 3例心功能未恢复,1例术后2 d死亡
    Maestas C, et al[13] 2019 美国 7 丙肝肝硬化4例、ALC 1例、PBC合并自身免疫性肝炎1例、NASH 1例 术后7 d 10~25 1例行ECMO+IABP 仅1例为典型心尖型 1例术后14 d死亡,其余好转出院
    Tanaka A, et al[14] 2019 日本 1 丙肝肝硬化合并肝癌 术后4 d 40 心尖型 好转出院
    Luu LA, et al[15] 2020 美国 1 NASH 术后3 d 15 弥漫型 好转出院
    Bedanova H, et al[16] 2021 捷克 1 ALC 术后1 d 25 中间型 好转出院
    Shamaa O, et al[17] 2021 美国 2 ALC 术后201 d,术后9 d 19~37 双心室型 1例术后1 d后死亡,1例术后20 d出院
    Yang J, et al[18] 2021 美国 38 ALC 17例、丙肝肝硬化7例、肝癌6例、NASH 5例、乙肝肝硬化1例、其他2例 术后1个月内,其中31例在术后5 d内 26±8 IABP 5例,ECMO 2例 - 均好转恢复
    注:①-为无数据。
    ②乙肝为乙型病毒性肝炎。
    下载: 导出CSV
  • [1] SINGH T, KHAN H, GAMBLE DT, et al. Takotsubo syndrome: pathophysiology, emerging concepts, and clinical implications[J]. Circulation, 2022, 145(13): 1002-1019. DOI: 10.1161/CIRCULATIONAHA.121.055854.
    [2] LEE HR, HURST RT, VARGAS HE. Transient left ventricular apical ballooning syndrome (Takotsubo cardiomyopathy) following orthotopic liver transplantation[J]. Liver Transpl, 2007, 13(9): 1343-1345. DOI: 10.1002/lt.21169.
    [3] ANISKEVICH S, CHADHA RM, PEIRIS P, et al. Intra-operative predictors of postoperative Takotsubo syndrome in liver transplant recipients-an exploratory case-control study[J]. Clin Transplant, 2017, 31(11): e13092. DOI: 10.1111/ctr.13092.
    [4] PHILLIPS MS, PRUETT TL, BERG CL, et al. Takotsubo cardiomyopathy in a liver transplant recipient: a diagnosis of exclusion?[J]. J Cardiothorac Vasc Anesth, 2009, 23(2): 268-269. DOI: 10.1053/j.jvca.2008.08.013.
    [5] SANER FH, PLICHT B, TRECKMANN J, et al. Tako-Tsubo syndrome as a rare cause of cardiac failure in liver transplantation[J]. Liver Int, 2010, 30(1): 159-160. DOI: 10.1111/j.1478-3231.2009.02062.x.
    [6] ANDERS MM, COMIGNANI PD, COUCE R, et al. Takotsubo cardiomyopathy: a cardiac syndrome mimicking acute myocardial infarction in a liver transplant recipient[J]. Cardiol Res, 2011, 2(2): 82-85. DOI: 10.4021/cr35e.
    [7] TACHOTTI PIRES LJ, CARDOSO CURIATI MN, VISSOCI REICHE F, et al. Stress-induced cardiomyopathy (Takotsubo cardiomyopathy) after liver transplantation-report of two cases[J]. Transplant Proc, 2012, 44(8): 2497-2500. DOI: 10.1016/j.transproceed.2012.07.037.
    [8] BEDANOVA H, ORBAN M, NEMEC P. Postoperative left ventricular apical ballooning: transient Takotsubo cardiomyopathy following orthotopic liver transplantation[J]. Am J Case Rep, 2013, 14: 494-497. DOI: 10.12659/AJCR.889102.
    [9] VACHIAT A, MCCUTCHEON K, MAHOMED A, et al. Takotsubo cardiomyopathy post liver transplantation[J]. Cardiovasc J Afr, 2016, 27(5): e1-e3. DOI: 10.5830/CVJA-2016-032.
    [10] BIONDI RS, BARZILAI VS, WATANABE ALC, et al. Use of extracorporeal membrane oxygenation for treating acute cardiomyopathy after liver transplantation: a case report[J]. Rev Bras Ter Intensiva, 2018, 30(2): 233-236. DOI: 10.5935/0103-507X.20180029.
    [11] REDDY RV, AGARWAL S, CHOUDHARY V, et al. Reverse stress cardiomyopathy post-liver transplant needing mechanical circulatory support[J]. Indian J Anaesth, 2018, 62(12): 988-990. DOI: 10.4103/ija.IJA_402_18.
    [12] GALVÁN NT, KUMM K, KUEHT M, et al. Mending a broken heart: treatment of stress-induced heart failure after solid organ transplantation[J]. J Transplant, 2018: 9739236. DOI: 10.1155/2018/9739236.
    [13] MAESTAS C, LAZKANI M, SULTAN M, et al. Severe Takotsubo cardiomyopathy following orthotopic liver transplantation: a case series[J]. Clin Res Hepatol Gastroenterol, 2019, 43(4): e48-e53. DOI: 10.1016/j.clinre.2018.11.009.
    [14] TANAKA A, ONOE T, ISHIYAMA K, et al. A rare case of transient left ventricular apical ballooning syndrome following living donor liver transplantation: a case report and literature review[J]. Int J Surg Case Rep, 2019, 55: 218-222. DOI: 10.1016/j.ijscr.2019.02.002.
    [15] LUU LA, RAWASHDEH B, GOLDARACENA N, et al. Hepatic artery thrombosis and Takotsubo syndrome after liver transplantation - which came first?[J]. Am J Case Rep, 2020, 21: e920263. DOI: 10.12659/AJCR.920263.
    [16] BEDANOVA H, ONDRASEK J, FILIPENSKY P, et al. Inverted Takotsubo cardiomyopathy as an early complication after liver transplantation[J]. Am J Case Rep, 2021, 22: e930484. DOI: 10.12659/AJCR.930484.
    [17] SHAMAA O, JAFRI SM, SHAMAA MT, et al. Takotsubo cardiomyopathy following liver transplantation: a report of 2 cases[J]. Transplant Proc, 2021, 53(1): 239-243. DOI: 10.1016/j.transproceed.2020.07.021.
    [18] YANG J, RAO Z, HONG F, et al. Takotsubo syndrome after liver transplantation: an association with intraoperatively administered epinephrine and fentanyl[J]. Clin Transplant, 2021, 35(11): e14463. DOI: 10.1111/ctr.14463.
    [19] AGARWAL S, BEAN MG, HATA JS, et al. Perioperative Takotsubo cardiomyopathy: a systematic review of published cases[J]. Semin Cardiothorac Vasc Anesth, 2017, 21(4): 277-290. DOI: 10.1177/1089253217700511.
    [20] TEMPLIN C, GHADRI JR, DIEKMANN J, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy[J]. N Engl J Med, 2015, 373(10): 929-938. DOI: 10.1056/NEJMoa1406761.
    [21] 冉倩, 周霞, 孙亚洲, 等. 中国与欧美Takotsubo综合征患者临床特征的比较[J]. 中华心血管病杂志, 2022, 50(4): 386-394. DOI: 10.3760/cma.j.cn112148-20220304-00152.

    RAN Q, ZHOU X, SUN YZ, et al. Comparison on the clinical characteristics of patients with Takotsubo syndrome from China and from Europe/North America[J]. Chin J Cardiol, 2022, 50(4): 386-394. DOI: 10.3760/cma.j.cn112148-20220304-00152.
    [22] ASSAD J, FEMIA G, PENDER P, et al. Takotsubo syndrome: a review of presentation, diagnosis and management[J]. Clin Med Insights Cardiol, 2022, 16: 11795468211065782. DOI: 10.1177/11795468211065782.
    [23] NAGAI M, KOBAYASHI Y, KOBATAKE H, et al. Happy heart syndrome: a case of Takotsubo syndrome with left internal carotid artery occlusion[J]. Clin Auton Res, 2020, 30(4): 347-350. DOI: 10.1007/s10286-020-00696-z.
    [24] GHADRI JR, WITTSTEIN IS, PRASAD A, et al. International expert consensus document on Takotsubo syndrome (part Ⅰ): clinical characteristics, diagnostic criteria, and pathophysiology[J]. Eur Heart J, 2018, 39(22): 2032-2046. DOI: 10.1093/eurheartj/ehy076.
    [25] EL HADI H, DI VINCENZO A, VETTOR R, et al. Relationship between heart disease and liver disease: a two-way street[J]. Cells, 2020, 9(3): 567. DOI: 10.3390/cells9030567.
    [26] GIBSON LE, KLINKER MR, WOOD MJ. Variants of Takotsubo syndrome in the perioperative period: a review of potential mechanisms and anaesthetic implications[J]. Anaesth Crit Care Pain Med, 2020, 39(5): 647-654. DOI: 10.1016/j.accpm.2020.01.010.
    [27] GUGLIN M, NAZIF K. New onset nonischemic cardiomyopathy post liver transplantation[J]. Heart Fail Rev, 2021, 27(5): 1829-1836. DOI: 10.1007/s10741-021-10196-5.
    [28] PRASAD A, LERMAN A, RIHAL CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction[J]. Am Heart J, 2008, 155(3): 408-417. DOI: 10.1016/j.ahj.2007.11.008.
    [29] WITTSTEIN IS. Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning?[J]. Cell Mol Neurobiol, 2012, 32(5): 847-857. DOI: 10.1007/s10571-012-9804-8.
    [30] KAWAI S, KITABATAKE A, TOMOIKE H, et al. Guidelines for diagnosis of Takotsubo (ampulla) cardiomyopathy[J]. Circ J, 2007, 71(6): 990-992. DOI: 10.1253/circj.71.990.
    [31] PARODI G, CITRO R, BELLANDI B, et al. Revised clinical diagnostic criteria for Tako-tsubo syndrome: the Tako-tsubo Italian Network proposal[J]. Int J Cardiol, 2014, 172(1): 282-283. DOI: 10.1016/j.ijcard.2013.12.239.
    [32] GHADRI JR, WITTSTEIN IS, PRASAD A, et al. International expert consensus document on Takotsubo syndrome (part Ⅱ): diagnostic workup, outcome, and management[J]. Eur Heart J, 2018, 39(22): 2047-2062. DOI: 10.1093/eurheartj/ehy077.
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出版历程
  • 收稿日期:  2022-04-04
  • 网络出版日期:  2022-09-14
  • 刊出日期:  2022-09-15

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