Ferreira Rita de Cassia dos Santos, Domingues Ana Lúcia Coutinho, Markman Filho Brivaldo, Veras Flávio Henrique Amaral Pires, Batista Luiz José de Barros, Albuquerque Filho Eolo Santana
Hospital Universtário Oswaldo Cruz, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, CEP 50100-130, Recife, PE, Brazil.
Acta Trop. 2009 Aug;111(2):119-24. doi: 10.1016/j.actatropica.2009.03.005. Epub 2009 Mar 25.
Hepatopulmonary syndrome (HPS) is characterized by the presence of liver disease, arterial hypoxemia and intrapulmonary vascular dilatation (IPVD). IPVD includes diffused or localized dilated pulmonary capillaries and, less commonly, pleural and pulmonary arteriovenous communications. The aim of the present study was to investigate the occurrence of HPS in patients with Schistosoma mansoni periportal fibrosis in treatment at a university hospital in northeastern Brazil.
Eighty-four patients were enrolled in the study between April and July 2007 and underwent arterial blood gas analysis. Patients with an alveolar-arterial oxygen gradient (DA-aO(2)) > or = 15 mmHg were submitted to contrast-enhanced transthoracic echocardiogram (CE-TTE) with saline microbubbles. The diagnostic criterion for HPS was DA-aO(2) > or = 15 mmHg associated to IPVD, as identified through CE-TTE. Patients with HPS underwent contrast-enhanced 16-channel multidetector-row computed tomography (MDCT) of the thorax.
Twenty-two patients (26.19%) had DA-aO(2) > or = 15 mmHg (mean value=20.86+/-7.91). CE-TTE was positive for IPVD in five of the 22 patients with DA-aO(2) > or = 15 mmHg and all these patients had hepatosplenic disease, revealing a 6% prevalence of HPS (CI: 1.96-13.35) in the overall population of 84 patients, with a 10.2% prevalence in the group with hepatosplenic disease. The following were the 16-channel MDCT findings in these five patients: dilated peripheral pulmonary vasculature (100%); ratio of segmental arterial diameter to adjacent bronchial diameter equal to or greater than 2:1 (100%); higher number of visible terminal vessel branches in lung dependent regions (40%); and micronodules associated with subpleural surface centrilobular vessels (40%). No patient had evidence of arteriovenous fistula. These findings reveal that HPS occurs (usually in a mild form) in patients with Schistosoma mansoni periportal fibrosis and portal hypertension seems to be an important factor related to the occurrence of HPS in such cases.
肝肺综合征（HPS）的特征为存在肝脏疾病、动脉血氧不足和肺内血管扩张（IPVD）。IPVD包括弥漫性或局限性扩张的肺毛细血管，较少见的还有胸膜和肺动静脉分流。本研究的目的是调查巴西东北部一家大学医院正在接受治疗的曼氏血吸虫性门周纤维化患者中HPS的发生率。
2007年4月至7月期间，84例患者纳入本研究并接受动脉血气分析。肺泡-动脉氧梯度（DA-aO₂）≥15 mmHg的患者接受经胸超声心动图造影（CE-TTE）检查，使用生理盐水微泡。HPS的诊断标准为DA-aO₂≥15 mmHg且伴有IPVD，通过CE-TTE确定。HPS患者接受胸部增强16排多层螺旋CT（MDCT）检查。
22例患者（26.19%）的DA-aO₂≥15 mmHg（平均值=20.86±7.91）。在DA-aO₂≥15 mmHg的22例患者中，5例CE-TTE显示IPVD阳性，所有这些患者均有肝脾疾病，表明在84例患者的总体人群中HPS患病率为6%（CI：1.96 - 13.35），在肝脾疾病组中患病率为10.2%。这5例患者的16排MDCT检查结果如下：外周肺血管扩张（100%）；段动脉直径与相邻支气管直径之比等于或大于2:1（100%）；肺下垂部位可见终末血管分支数量增加（40%）；与胸膜下表面小叶中心血管相关的微小结节（40%）。无患者有动静脉瘘的证据。这些结果表明，曼氏血吸虫性门周纤维化患者会发生HPS（通常为轻度），门静脉高压似乎是此类病例中HPS发生的一个重要相关因素。
