Lamps L W, Carson K, Bradley A L, Pinson C W, Johnson J E, Coogan A C, Hunter E B, Clavien P A, Washington M K
Department of Pathology, Vanderbilt University, Nashville, TN, USA.
Liver Transpl Surg. 1999 Jan;5(1):57-64. doi: 10.1002/lt.500050110.
Cirrhosis and portal hypertension may be associated with pulmonary hypertension and pulmonary dysfunction. However, morphological pulmonary vascular lesions in patients with cirrhosis have not been well characterized morphometrically. We morphometrically evaluated pulmonary vessels in liver transplant recipients with pretransplantation cirrhosis and correlated our findings with pretransplantation cardiopulmonary function, postoperative course, and postmortem cardiopulmonary findings. Autopsy lung slides from 23 transplant recipients with pretransplantation cirrhosis were examined. External vessel diameter, intimal thickness, and arterial medial thickness were measured with a micrometer after pentachrome staining. The percent of total diameter comprised by intima or media was calculated for each vessel. Medical records were reviewed for smoking history, pretransplantation cardiopulmonary function testing, and postoperative course. Autopsy cases without liver or significant cardiopulmonary diseases, matched for age, sex, and smoking history, served as controls. Transplant recipients had significantly more pulmonary venous intimal thickening than matched controls (P <.0001). Sixty-five percent (15 of 23) of these patients had some degree of pretransplantation pulmonary dysfunction, defined by abnormalities in pulmonary function tests, oxygen saturation, and/or increased pulmonary artery pressures. However, the severity of venous intimal thickening did not correlate with the severity of pretransplantation pulmonary dysfunction. Arterial intimal and medial thickness were not statistically significantly different from controls. Pulmonary venous intimal thickening and resultant luminal impingement are morphological findings not previously described in this population. The arterial lesion, when present, is similar to that seen in pulmonary hypertension from other causes. These pulmonary vascular lesions may be implicated in pulmonary dysfunction in patients with cirrhosis and may be associated with increased posttransplantation cardiopulmonary morbidity and mortality.
肝硬化和门静脉高压可能与肺动脉高压及肺功能障碍相关。然而，肝硬化患者肺部血管的形态学病变尚未通过形态计量学得到充分表征。我们对肝移植受者中移植前患有肝硬化的肺部血管进行了形态计量学评估，并将我们的发现与移植前的心肺功能、术后病程以及尸检时的心肺检查结果相关联。检查了23例移植前患有肝硬化的受者的尸检肺切片。在进行丽春红染色后，用测微计测量血管外径、内膜厚度和动脉中膜厚度。计算每条血管内膜或中膜占总直径的百分比。查阅医疗记录以了解吸烟史、移植前心肺功能测试及术后病程。年龄、性别和吸烟史相匹配的无肝脏或严重心肺疾病的尸检病例作为对照。移植受者的肺静脉内膜增厚明显多于匹配的对照组（P<.0001）。这些患者中有65%（23例中的15例）存在一定程度的移植前肺功能障碍，其定义为肺功能测试、血氧饱和度异常和/或肺动脉压力升高。然而，静脉内膜增厚的严重程度与移植前肺功能障碍的严重程度并无相关性。动脉内膜和中膜厚度与对照组相比无统计学显著差异。肺静脉内膜增厚及由此导致的管腔受压是该人群此前未曾描述过的形态学表现。存在的动脉病变与其他原因导致的肺动脉高压中所见病变相似。这些肺部血管病变可能与肝硬化患者的肺功能障碍有关，并可能与移植后心肺发病率和死亡率增加相关。
