Colle Isabelle, Langlet Philippe, Barrière Eric, Heller Jörg, Rassiat Emmanuel, Condat Bertrand, Carayon Alain, Valla Dominique, Moreau Richard, Lebrec Didier
Laboratoire d'Hémodynamique Splanchnique et de Biologie Vasculaire, INSERM U-481 and Service d'Hépatologie, Hôpital Beaujon, Clichy, France.
J Gastroenterol Hepatol. 2002 Oct;17(10):1106-9. doi: 10.1046/j.1440-1746.2002.02849.x.
Hypoxemia is common in patients with cirrhosis but the natural history of this syndrome is unknown. The aim of this study was to follow a series of patients with cirrhosis and to compare patients with and without hypoxemia to determine their risk of complications and survival rate.
Fifty-eight consecutive Child-Pugh C patients with cirrhosis were included and followed up for 1-18 months. Blood gas measurements and plasma endothelin levels were measured in all patients. Blood gas measurements were repeated in 34 patients.
Hypoxemia was present in 35 patients (60%) (alveolar-arterial oxygen (AaO2) gradient > 20 mmHg) but none had pulmonary symptoms. There was no significant difference in liver tests and plasma endothelin levels between hypoxemic and non-hypoxemic patients. The occurrence of variceal bleeding and survival rate was not significantly different between the two groups. The AaO2 gradient worsened in nine patients and normalized in six of the hypoxemic patients. The AaO2 gradient increased to more than 20 mmHg in seven non-hypoxemic patients. There was no relationship between AaO2 gradient changes and Child-Pugh score grade changes.
Asymptomatic hypoxemia is common in patients with severe cirrhosis but it is not a predictive factor of short-term complications or mortality. These results should be considered when deciding on liver transplantation.
低氧血症在肝硬化患者中很常见，但该综合征的自然病程尚不清楚。本研究的目的是对一系列肝硬化患者进行随访，并比较有低氧血症和无低氧血症的患者，以确定他们发生并发症的风险和生存率。
纳入58例连续的Child-Pugh C级肝硬化患者，随访1至18个月。对所有患者进行血气测量和血浆内皮素水平测定。34例患者重复进行血气测量。
35例患者（60%）存在低氧血症（肺泡-动脉血氧（AaO2）梯度>20 mmHg），但均无肺部症状。低氧血症患者和非低氧血症患者的肝功能检查和血浆内皮素水平无显著差异。两组之间静脉曲张出血的发生率和生存率无显著差异。9例患者的AaO2梯度恶化，6例低氧血症患者的AaO2梯度恢复正常。7例非低氧血症患者的AaO2梯度增加至超过20 mmHg。AaO2梯度变化与Child-Pugh评分等级变化之间无相关性。
无症状性低氧血症在重度肝硬化患者中很常见，但它不是短期并发症或死亡率的预测因素。在决定肝移植时应考虑这些结果。
