Kaymakoglu Sabahattin, Kahraman Tevfik, Kudat Hasan, Demir Kadir, Cakaloglu Yilmaz, Adalet Isik, Dincer Dinc, Besisik Fatih, Boztas Güngör, Sözen Ahmet Bilge, Mungan Zeynel, Okten Atilla
Division of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Dig Dis Sci. 2003 Mar;48(3):556-60. doi: 10.1023/a:1022549018807.
Hepatopulmonary syndrome has yet not been sufficiently assessed in noncirrhotic portal hypertension. The prevalence of hepatopulmonary syndrome was determined in 31 consecutive patients with noncirrhotic portal hypertension (19 idiopathic portal hypertension, 7 portal vein thrombosis, 5 congenital hepatic fibrosis) and 46 patients with liver cirrhosis. Contrast echocardiography was carried out in all patients. Macroaggregated albumin lung perfusion scans were performed in patients with positive contrast echocardiogram. Hepatopulmonary syndrome was detected in 5 (10.8%) cirrhotic and 3 (9.7%) noncirrhotic portal hypertensive patients (2 idiopathic portal hypertension, 1 portal vein thrombosis). All patients with hepatopulmonary syndrome had an increased shunt fraction (13-62%) and a decreased diffusion capacity of carbon monoxide (40-79%), and 7 of them were hypoxemic (PaO2, 31.6-69.8 mm Hg). These findings show that hepatopulmonary syndrome may occur in both liver cirrhosis and noncirrhotic portal hypertension and that portal hypertension is the predominant etiopathogenic factor related to hepatopulmonary syndrome.
肝肺综合征在非肝硬化性门静脉高压症中尚未得到充分评估。我们测定了31例连续性非肝硬化性门静脉高压症患者（19例特发性门静脉高压症、7例门静脉血栓形成、5例先天性肝纤维化）和46例肝硬化患者的肝肺综合征患病率。所有患者均接受了对比超声心动图检查。对比超声心动图检查结果为阳性的患者进行了大颗粒白蛋白肺灌注扫描。在5例（10.8%）肝硬化患者和3例（9.7%）非肝硬化性门静脉高压症患者（2例特发性门静脉高压症、1例门静脉血栓形成）中检测到肝肺综合征。所有肝肺综合征患者的分流分数均升高（13%-62%），一氧化碳弥散能力降低（40%-79%），其中7例存在低氧血症（动脉血氧分压，31.6-69.8 mmHg）。这些结果表明，肝肺综合征可能发生于肝硬化和非肝硬化性门静脉高压症患者中，且门静脉高压是与肝肺综合征相关的主要致病因素。
