Henrion J, Colin L, Schapira M, Heller F R
Department of Internal Medicine (Gastroenterology), Hôpital de Jolimont, Haine-Saint-Paul, Belgium.
J Clin Gastroenterol. 1997 Jun;24(4):245-9. doi: 10.1097/00004836-199706000-00013.
Cardiac and circulatory failure are the main causes of hypoxic hepatitis. In a prospective study of 142 cases of hypoxic hepatitis collected during a 10-year period, we encountered two cases resulting from extreme arterial hypoxemia without congestive heart failure, cor pulmonale, or circulatory failure. Both patients were morbidly obese women admitted to the intensive care unit for carbonarcosis. Oxygen arterial saturation was very low, less than 35% in both patients, but there was no history of cardiac or respiratory failure and no clinical evidence of circulatory failure. Cardiac function, evaluated by isotopic scintigraphy, was normal. After the episode of hypoxic hepatitis, a diagnosis of obstructive sleep apnea was made clinically and confirmed by performing nocturnal oximetry, which showed multiple episodes of oxygen desaturation in both patients. Polysonography could be performed in one case and was typical of obstructive sleep apnea. Liver ischemia is the main mechanism leading to hypoxic hepatitis. More recently, the role of passive congestion of the liver has been emphasized. Arterial hypoxemia, however, is generally considered to be a minor factor. Our two cases support the hypothesis that severe arterial hypoxemia may lead to hypoxic hepatitis even in the absence of cardiac and circulatory failure.
心脏和循环衰竭是缺氧性肝炎的主要病因。在一项对10年间收集的142例缺氧性肝炎病例的前瞻性研究中，我们遇到了2例由极端动脉血氧不足导致的病例，这些病例并无充血性心力衰竭、肺心病或循环衰竭。两名患者均为病态肥胖女性，因二氧化碳麻醉入住重症监护病房。动脉血氧饱和度极低，两名患者均低于35%，但既往无心脏或呼吸衰竭病史，也无循环衰竭的临床证据。通过同位素闪烁扫描评估的心脏功能正常。在发生缺氧性肝炎后，临床上诊断为阻塞性睡眠呼吸暂停，并通过夜间血氧测定法得到证实，结果显示两名患者均有多次氧饱和度下降。其中1例患者进行了多导睡眠图检查，结果典型地显示为阻塞性睡眠呼吸暂停。肝脏缺血是导致缺氧性肝炎的主要机制。最近，肝脏被动充血的作用也得到了强调。然而，动脉血氧不足通常被认为是一个次要因素。我们的这两个病例支持了这样一种假说，即即使在没有心脏和循环衰竭的情况下，严重的动脉血氧不足也可能导致缺氧性肝炎。
