Lee J H, Lee D H, Zo J H, Kim T H, Lee K L, Chung H S, Kim C H, Han S K, Sim Y S, Lee H S, Yoon Y B, Song I S, Kim C Y
Department of Internal Medicine, Liver Research Institute, Seoul Municipal Boramae Hospital, Seoul, Korea.
Korean J Intern Med. 2001 Jun;16(2):56-61. doi: 10.3904/kjim.2001.16.2.56.
Hepatopulmonary syndrome (HPS) refers to the association of hypoxemia, intrapulmonary shunting and chronic liver disease. But there is no clear data about the prevalence of HPS in postnecrotic liver cirrhosis by hepatitis B virus (HBV), the most common cause of liver disease in Korea. The aim of this study was to investigate the prevalence of HPS in poorly compensated postnecrotic liver cirrhosis by HBV, and the correlation of the hepatopulmonary syndrome with clinical aspects of postnecrotic liver cirrhosis by HBV.
Thirty-five patients underwent pulmonary function test, arterial blood gas analysis and contrast-enhanced echocardiography. All patients were diagnosed as HBV-induced Child class C liver cirrhosis and had no evidence of intrinsic cardiopulmonary disease.
Intrapulmonary shunt was detected in 6/35 (17.1%) by contrast-enhanced echocardiography. Two of six patients with intrahepatic shunts had significant hypoxemia (PaO2 < 70 mmHg) and four showed increased alveolar-arterial oxygen gradient over 20 mmHg. Only cyanosis could reliably distinguish between shunt positive and negative patients.
The prevalence of intrapulmonary shunt in poorly compensated postnecrotic liver cirrhosis by HBV was 17.1% and the frequency of hepatopulmonary syndrome was relatively low (5.7%). 'Subclinical' hepatopulmonary syndrome (echocardiographically positive intrapulmonary shunt but without profound hypoxemia) exists in 11.4% of cases with poorly compensated postnecrotic liver cirrhosis by HBV. Cyanosis is the only reliable clinical indicator of HPS of HBV-induced poorly compensated liver cirrhosis. Further studies are required to determine if the prevalence and clinical manifestations of HPS varies with etiology or with geographical and racial differences.
肝肺综合征（HPS）指的是低氧血症、肺内分流与慢性肝病的关联。但对于韩国最常见的肝病病因——乙型肝炎病毒（HBV）所致坏死性肝硬化中HPS的患病率，尚无明确数据。本研究旨在调查HBV所致失代偿性坏死性肝硬化中HPS的患病率，以及肝肺综合征与HBV所致坏死性肝硬化临床特征的相关性。
35例患者接受了肺功能测试、动脉血气分析和对比增强超声心动图检查。所有患者均被诊断为HBV所致Child C级肝硬化，且无内在心肺疾病证据。
对比增强超声心动图检查发现35例中有6例（17.1%）存在肺内分流。6例肝内分流患者中有2例出现明显低氧血症（动脉血氧分压<70 mmHg），4例肺泡-动脉氧分压差升高超过20 mmHg。只有发绀能够可靠地区分分流阳性和阴性患者。
HBV所致失代偿性坏死性肝硬化中肺内分流的患病率为17.1%，肝肺综合征的发生率相对较低（5.7%）。在HBV所致失代偿性坏死性肝硬化患者中，11.4%存在“亚临床”肝肺综合征（超声心动图显示肺内分流阳性但无严重低氧血症）。发绀是HBV所致失代偿性肝硬化肝肺综合征唯一可靠的临床指标。需要进一步研究以确定HPS的患病率和临床表现是否因病因或地理及种族差异而有所不同。
