Benz Fabian, Mohr Raphael, Tacke Frank, Roderburg Christoph
Charité University Medicine Berlin, Department of Hepatology & Gastroenterology, Campus Virchow Klinikum and Campus Charité Mitte, Berlin, Germany.
J Transl Int Med. 2020 Sep 25;8(3):150-158. doi: 10.2478/jtim-2020-0024. eCollection 2020 Sep.
Patients with advanced chronic liver diseases, particularly with decompensated liver cirrhosis, can develop specific pulmonary complications independently of any pre-existing lung disease. Especially when dyspnea occurs in combination with liver cirrhosis, patients should be evaluated for hepato-pulmonary syndrome (HPS), porto-pulmonary hypertension (PPHT), hepatic hydrothorax and spontaneous bacterial empyema, which represent the clinically most relevant pulmonary complications of liver cirrhosis. Importantly, the pathophysiology, clinical features, diagnosis and the corresponding therapeutic options differ between these entities, highlighting the role of specific diagnostics in patients with liver cirrhosis who present with dyspnea. Liver transplantation may offer a curative therapy, including selected cases of HPS and PPHT. In this review article, we summarize the pathogenesis, clinical features, diagnostic algorithms and treatment options of the 4 specific pulmonary complications in patients with liver cirrhosis.
晚期慢性肝病患者，尤其是失代偿期肝硬化患者，可独立于任何既往存在的肺部疾病而出现特定的肺部并发症。特别是当呼吸困难与肝硬化同时出现时，应评估患者是否患有肝肺综合征（HPS）、门脉性肺动脉高压（PPHT）、肝性胸腔积液和自发性细菌性脓胸，这些是肝硬化临床上最相关的肺部并发症。重要的是，这些疾病实体在病理生理学、临床特征、诊断及相应治疗选择方面存在差异，凸显了对出现呼吸困难的肝硬化患者进行特异性诊断的作用。肝移植可能提供一种治愈性疗法，包括HPS和PPHT的某些病例。在这篇综述文章中，我们总结了肝硬化患者4种特定肺部并发症的发病机制、临床特征、诊断算法及治疗选择。
