Hopkins W E, Waggoner A D, Barzilai B
Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri 63110.
Am J Cardiol. 1992 Aug 15;70(4):516-9. doi: 10.1016/0002-9149(92)91200-n.
Intrapulmonary vascular abnormalities consisting of arteriovenous malformations and capillary dilatations have been described in patients with severe liver disease. These intrapulmonary vascular abnormalities can result in intrapulmonary right-to-left shunting and hypoxemia. Twenty-five of 53 patients (47%) with end-stage hepatic disease were found to have contrast echocardiographic evidence of intrapulmonary right-to-left shunting. There was no difference in mean age, gender distribution, or severity of hepatic disease in those with and without evidence of such shunting. Although there was no difference in mean partial arterial oxygen pressure (PaO2) values in the 2 groups (82 +/- 11 vs 76 +/- 11 mm Hg), the mean PaO2 value of those with at least 2+ left ventricular opacification (2 to 4+) was significantly lower (66 +/- 3 mm Hg, n = 8; p less than 0.01). Unexpectedly, patients with evidence of intrapulmonary shunting had a lower mortality rate before transplantation (3 of 25, 12%) than those without evidence of shunting (10 of 28, 36%) resulting in a significant difference in actuarial survival (p less than 0.05) by the end of the follow-up period. It is concluded that intrapulmonary right-to-left shunting occurs frequently in patients with end-stage liver disease and may be a marker of a positive biologic process that, in some way, leads to improved short-term survival.
严重肝病患者中已发现存在由动静脉畸形和毛细血管扩张组成的肺内血管异常。这些肺内血管异常可导致肺内右向左分流和低氧血症。53例终末期肝病患者中有25例（47%）经超声心动图造影证实存在肺内右向左分流。有或无此类分流证据的患者在平均年龄、性别分布或肝病严重程度方面无差异。虽然两组的平均动脉血氧分压（PaO2）值无差异（82±11 vs 76±11 mmHg），但左心室显影至少为2+（2至4+）的患者的平均PaO2值显著降低（66±3 mmHg，n = 8；p<0.01）。出乎意料的是，有肺内分流证据的患者移植前的死亡率（25例中有3例，12%）低于无分流证据的患者（28例中有10例，36%），导致随访期末精算生存率有显著差异（p<0.05）。结论是，终末期肝病患者中肺内右向左分流频繁发生，可能是一种积极生物学过程的标志，该过程以某种方式导致短期生存率提高。
