Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran.
Indian J Pediatr. 2011 Feb;78(2):171-5. doi: 10.1007/s12098-010-0216-9. Epub 2010 Oct 2.
Liver transplantation (LT) maybe complicated by pulmonary problems. This study aimed to evaluate pulmonary function and gas exchange abnormalities in pediatric patients listing for LT.
In total, 79 pediatric patients with advanced liver disease were included in the study. Pulmonary function test, contrast echocardiography and arterial blood gases analyses and chest radiography were performed for all the patients. Patients with and without hepatopulmonary syndrome (HPS) as well as patients with and without severe hypoxemia (partial pressure of arterial oxygen, PaO(2)<60 mmHg) were compared regarding clinical and paraclinical characteristics.
The most common causes for liver disease were cryptogenic cirrhosis, biliary atresia and autoimmune cirrhosis. Clubbing (n=27) and cyanosis (n=9) were the most common abnormalities in physical exam. Nine patients (11.4%) were found to have HPS. PaO(2) was 52.9 ± 10.4 mmHg in HPS patients while it was 73.7 ± 28 mmHg in non-HPS patients (p=0.03). Twenty eight patients had severe hypoxemia. Partial pressure of arterial carbon dioxide (PaCO(2)) was higher among patients with severe hypoxemia (p=0.001).
Pulmonary evaluation must be performed in all pediatric patients before LT. HPS is not so common among pediatric patients while hypoxemic patients may include a larger proportion of pediatric patients listing for LT.
肝移植（LT）可能会并发肺部问题。本研究旨在评估等待 LT 的儿科患者的肺功能和气体交换异常。
共有 79 例晚期肝病患儿纳入本研究。对所有患者进行肺功能检查、对比超声心动图、动脉血气分析和胸部 X 线检查。比较有和无肝肺综合征（HPS）以及有和无严重低氧血症（动脉血氧分压，PaO2<60mmHg）的患者的临床和辅助检查特征。
最常见的肝病病因是隐源性肝硬化、胆道闭锁和自身免疫性肝硬化。指（趾）甲床发绀（n=27）和发绀（n=9）是体格检查中最常见的异常。9 例（11.4%）患者存在 HPS。HPS 患者的 PaO2 为 52.9±10.4mmHg，而非 HPS 患者的 PaO2 为 73.7±28mmHg（p=0.03）。28 例患者存在严重低氧血症。严重低氧血症患者的 PaCO2 更高（p=0.001）。
所有 LT 前的儿科患者都必须进行肺部评估。HPS 在儿科患者中并不常见，而低氧血症患者可能包括更大比例的 LT 患儿。
