Rolla G, Brussino L, Colagrande P, Dutto L, Polizzi S, Scappaticci E, Bergerone S, Morello M, Marzano A, Martinasso G, Salizzoni M, Bucca C
Dipartimento di Scienze Biomediche e Oncologia Umana, Università di Torino, Italy.
Hepatology. 1997 Oct;26(4):842-7. doi: 10.1053/jhep.1997.v26.pm0009328302.
Impaired arterial oxygenation, ranging from increased alveolar-arterial oxygen gradient (AaDo2) to hypoxemia, is commonly present in patients with cirrhosis. Nitric oxide (NO), through pulmonary vasodilatation, may play a major role in the oxygen abnormalities of cirrhosis. Our aim was to study the relationship between NO production and O2 abnormalities in 45 nonsmoking patients with cirrhosis and without major cardiovascular and respiratory diseases. Intrapulmonary shunting was detected by contrast-enhanced (CE) echocardiography. Lung volumes and diffusion, arterial blood gas analysis, serum NO2-/NO3-, NO output in the exhaled air, and cardiac index by the echocardiographic method were determined in all patients. Twenty-seven (60%) patients had an abnormally increased (> 15 mm Hg) AaDo2. The mean values of exhaled NO output and serum NO2-/NO3- were significantly higher in cirrhotic patients than in controls (252 +/- 117 vs. 75.2 +/- 19 nL/min/m2, P < .0001; and 47.5 +/- 29.4 vs. 32.9 +/- 10.1 micromol/L, P < .02, respectively). In all patients, there was a significant correlation between exhaled NO and AaDo2 (r = .78, P < .0001). Twelve patients (26.6%) were found to have CE-echocardiographic evidence of intrapulmonary shunting (positive CE-echo). Nine patients were considered to have hepatopulmonary syndrome (HPS) on the basis of an AaDo2 > 15 mm Hg and positive CE-echo. These 9 patients had a mean value of exhaled NO significantly higher than patients without HPS (331 +/- 73.2 vs. 223 +/- 118.4 nL/min/m2, P < .05). In all patients, cardiac index was positively correlated with exhaled NO (r = .47, P < .001) and with serum NO2-/NO3- (r = .43, P < .01). The results suggest an important role of NO in the oxygenation and circulatory abnormalities of patients with cirrhosis.
动脉氧合受损，从肺泡-动脉氧梯度（AaDo2）增加到低氧血症，在肝硬化患者中普遍存在。一氧化氮（NO）通过肺血管舒张，可能在肝硬化的氧异常中起主要作用。我们的目的是研究45例无重大心血管和呼吸系统疾病的非吸烟肝硬化患者中NO产生与氧异常之间的关系。通过对比增强（CE）超声心动图检测肺内分流。测定所有患者的肺容积和弥散、动脉血气分析、血清NO2-/NO3-、呼出气体中的NO输出以及超声心动图法测定的心指数。27例（60%）患者的AaDo2异常升高（>15mmHg）。肝硬化患者呼出NO输出和血清NO2-/NO3-的平均值显著高于对照组（分别为252±117 vs.75.2±19nL/min/m2，P<.0001；47.5±29.4 vs.32.9±10.1μmol/L，P<.02）。在所有患者中，呼出NO与AaDo2之间存在显著相关性（r=.78，P<.0001）。12例患者（26.6%）被发现有CE超声心动图证据显示肺内分流（CE回声阳性）。9例患者根据AaDo2>15mmHg和CE回声阳性被认为患有肝肺综合征（HPS）。这9例患者呼出NO的平均值显著高于无HPS的患者（331±73.2 vs.223±118.4nL/min/m2，P<.05）。在所有患者中，心指数与呼出NO呈正相关（r=.47，P<.001），与血清NO2-/NO3-呈正相关（r=.43，P<.01）。结果表明NO在肝硬化患者的氧合和循环异常中起重要作用。
