Shijo H, Sasaki H, Sakata H, Kusuhara H, Ueki T, Okumura M
First Department of Internal Medicine, School of Medicine, Fukuoka University, Japan.
Gastroenterol Jpn. 1993 Feb;28(1):126-31. doi: 10.1007/BF02775013.
A patient with liver cirrhosis who exhibited marked hypoxemia is presented. An abnormal dilatation of intrapulmonary capillaries was evidenced by perfusion lung scan, contrast-enhanced echocardiography, and histological examinations of lungs. Serial perfusion lung scan disclosed that the radioisotope uptake by extrapulmonary organs was significantly increased and uptake by both lungs was significantly decreased during the state of severer hypoxemia. Shunt quantification method revealed that intrapulmonary right-to-left shunt ratio also paralleled the extent of hypoxemia. The pathophysiology of hepatopulmonary syndrome appeared to involve a reversible intrapulmonary vascular dilatation. The perfusion lung scan could semiquantitate the severity of intrapulmonary vascular dilatation and could offer the efficient method to follow their progress.
本文报告一例肝硬化患者出现明显低氧血症。肺灌注扫描、对比增强超声心动图及肺组织学检查均证实肺内毛细血管异常扩张。系列肺灌注扫描显示，在严重低氧血症状态下，肺外器官放射性同位素摄取显著增加，而双肺摄取显著减少。分流定量方法显示，肺内右向左分流率也与低氧血症程度平行。肝肺综合征的病理生理学似乎涉及可逆性肺血管扩张。肺灌注扫描可半定量肺血管扩张的严重程度，并可为追踪其进展提供有效方法。
