Evaluation of lung ventilation and alveolar permeability in cirrhosis.

UNLABELLED

This study sought to evaluate lung ventilation and alveolar permeability (AP) in patients with cirrhosis of the liver.

METHODS

Pulmonary function in 29 patients with cirrhosis was measured by 99mTc-DTPA aerosol inhalation lung scintigraphy, using commercial lung radio-aerosol delivery units. Equilibrium lung ventilation images were visually interpreted according to the presence or absence of inhomogeneous distribution, inverted base-to-apex gradient and segmental defects. Degree of AP damage to the upper, middle, lower and total right lung was expressed as the slopes of the time-activity curves from dynamic lung images. The patients were classified into three groups, according to cirrhotic severity, using the modified Child's classification (A = good; B = fair; C = poor). Twelve healthy nonsmokers (2 women, 10 men; 42-75 yr old) formed the control group, and all had normal chest radiographic and pulmonary function test results.

RESULTS

None of the 29 patients had significantly abnormal lung ventilation findings, but 13 had reduced lung ventilation in the basilar lung zone. The incidence of lung ventilation abnormalities was 20% (3 of 15), 50% (3 of 6) and 88% (7 of 8) in patients with nil, slight-to-moderate and moderate-to-severe ascites, respectively (p < 0.05 for nil versus moderate-to-severe ascites). The AP studies showed higher time-activity curve slopes for patients with cirrhosis than for normal control subjects. The slopes for the right total lung showed no significant differences among the three groups; however, those for right upper and right lower lung showed significant differences between some subgroups. In addition, albumin and bilirubin levels showed no significant correlation with slope values in cirrhotic patients.

CONCLUSION

Although lung ventilation is normal in most patients with cirrhosis of the liver (16 [55%] of 29 in the present study), the disease can predispose patients to AP damage; however, the degree of damage is not related to cirrhotic severity.