Kawut Steven M, Krowka Michael J, Trotter James F, Roberts Kari E, Benza Raymond L, Badesch David B, Taichman Darren B, Horn Evelyn M, Zacks Steven, Kaplowitz Neil, Brown Robert S, Fallon Michael B
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, Room 101, New York, NY 10032, USA.
Hepatology. 2008 Jul;48(1):196-203. doi: 10.1002/hep.22275.
Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure > 25 mm Hg, pulmonary vascular resistance > 240 dynes x second x cm(-5), and pulmonary capillary wedge pressure < or = 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio = 2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio = 0.24, 95% confidence interval 0.09-0.65, P = 0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension.
Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients with advanced liver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension.
肝肺综合征影响高达6%的晚期肝病患者，但这种并发症发生的预测因素和生物学机制尚不清楚。我们试图确定晚期肝病患者发生肝肺综合征的临床危险因素。我们在一项从三级医疗中心招募的门静脉高压患者前瞻性队列中进行了一项多中心病例对照研究。病例组的平均肺动脉压>25mmHg，肺血管阻力>240达因·秒·厘米⁻⁵，肺毛细血管楔压≤15mmHg。对照组经胸超声心动图显示右心室收缩压<40mmHg（如可估计）且右侧心脏形态正常。研究样本包括34例病例和141例对照。女性发生肝肺综合征的风险高于男性（校正比值比=2.90，95%置信区间1.20 - 7.01，P = 0.018）。自身免疫性肝炎与风险增加相关（校正比值比=4.02，95%置信区间1.14 - 14.23，P = 0.031），丙型肝炎感染与肝肺综合征风险降低相关（校正比值比=0.24，95%置信区间0.09 - 0.65，P = 0.005）。肝病严重程度与肝肺综合征风险无关。
女性和自身免疫性肝炎与晚期肝病患者肝肺综合征风险增加相关，而丙型肝炎感染与风险降低相关。因此，激素和免疫因素可能是肝肺综合征发生的重要因素。
