肝性胸水：关于一组63例的医院病例系列。

Mouelhi Leila, Daboussi Oussama, Cheffi Nadia, El Jery Kaouther, Said Yosra, Khedher Sana, Salem Mohamed, Dabbèche Radhouane, Houissa Fatma, Najjar Taoufik

Tunis Med. 2016 Dec;94(12):867.

BACKGROUND

Hepatic hydrothorax is a less common complication of cirrhosis with an estimated prevalence of 10- 15%. In the vast majority of cases, ascites are also present but significant pleural effusion may develop in patients without ascites. Hepatic hydrothorax is associated with cirrhosis whatever its etiology. The prognosis of hepatic hydrothorax remains unclear and is closely related to available therapeutic options. The aim of our study is to determine the prevalence of hydrothorax in cirrhotic patients, detail its clinical and therapeutic characteristics, and study the evolutive profile of cirrhotic patients with hydrothorax by comparing it to those without hydrothorax. We also search predictive factors of development of this complication in cirrhotic patients.

METHODS

We conduct a retrospective and case-control study including 63 cirrhotic patients with hepatic hydrothorax hospitalized in gastroenterology department of Charles Nicolle hospital of Tunis, during a period of fiveteen years, from January 2000 to January 2015.

RESULTS

The prevalence of hydrothorax was 14.5%. The mean age was 62 ± 14 years (range, 22- 86 years). The sex ratio H/F was 1.52. Hepatic hydrothorax was symptomatic in 35 patients. It was right-sided in 60%, left-sided in 24% and bilateral in 16% of cases. Hydrothorax was on average size abundance in 54% of cases. It was transsudatif in 52.5% of cases. Hepatitis C was the most frequent cause of cirrhosis (54%). Our results show that hepatic hydrothorax was present with important ascites in 35 patients. Hydrothorax was significantly related to Child-Pugh C severity of cirrhosis (p=0.0001). Hydrothorax occurence was significantly associated with a low level of albumin (p=0.001), an important hyponatremia (p=0.001) and a low prothrombin rate (p=0.02). A therapeutic thoracentesis was performed in 57% of cases. Diuretics based on spironolactone and furosemide were indicated in 30 patients. Evolution was favorable in 19 patients. Refractory hepatic hydrothorax was present in 31 patients. Death, in the days which follow the hospitalisation, was in 13 patients. The 5-years survival rate was 60%. The mean survival time of patients with hepatic hydrothorax was 8.41 years against 10.75 years at patients without hepatic hydrothorax.

CONCLUSION

Hepatic hydrothorax is a common complication in our study. The improvement of the prognosis of our patients would require a better therapeutic management and especially the possibility of orthotopic liver transplantation which is the optimal therapeutic option for patients with hepatic hydrothorax.

背景

肝性胸水是肝硬化较少见的并发症，估计患病率为10% - 15%。绝大多数情况下也存在腹水，但无腹水的患者也可能出现大量胸腔积液。无论病因如何，肝性胸水均与肝硬化相关。肝性胸水的预后仍不明确，且与现有治疗选择密切相关。我们研究的目的是确定肝硬化患者中胸水的患病率，详细描述其临床和治疗特征，并通过与无胸水的肝硬化患者比较，研究有胸水的肝硬化患者的演变情况。我们还探寻肝硬化患者发生这种并发症的预测因素。

方法

我们进行了一项回顾性病例对照研究，纳入了2000年1月至2015年1月期间在突尼斯查尔斯·尼科勒医院胃肠病科住院的63例患有肝性胸水的肝硬化患者，为期15年。

结果

胸水患病率为14.5%。平均年龄为62±14岁（范围22 - 86岁）。男女比例为1.52。35例患者的肝性胸水有症状。60%为右侧胸水，24%为左侧胸水，16%为双侧胸水。54%的病例胸水平均量较多。52.5%的病例为漏出液。丙型肝炎是肝硬化最常见的病因（54%）。我们的结果显示，35例患者的肝性胸水伴有大量腹水。胸水与肝硬化Child - Pugh C级严重程度显著相关（p = 0.0001）。胸水的发生与低白蛋白水平（p = 0.001）、严重低钠血症（p = 0.001）和低凝血酶原率（p = 0.02）显著相关。57%的病例进行了治疗性胸腔穿刺术。30例患者使用了基于螺内酯和呋塞米的利尿剂。19例患者病情好转。31例患者存在难治性肝性胸水。住院后数天内，13例患者死亡。5年生存率为60%。有肝性胸水患者的平均生存时间为8.41年，无肝性胸水患者为10.75年。