Portopulmonary hypertension in decompensated cirrhosis with refractory ascites
Portopulmonary hypertension in decompensated cirrhosis with refractory ascites
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DOI：
10.1136/gut.52.9.1355
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发表时间：
2003-09-01
期刊：
影响因子：
24.5
通讯作者：
Wong, F
中科院分区：
文献类型：
--
作者：
Benjaminov, FS;Prentice, M;Wong, F
背景：肝硬化和难治性腹水患者门脉高压（PPHTN）的患病率尚不清楚。它的存在可能会妨碍患者接受经颈静脉肝内门体分流术或肝移植作为其终末期肝硬变的确定性治疗。目的：确定PPHTN在这些患者中的患病率、可能的病因因素和发展的预测因素。（53名男性，9名女性;平均年龄54.5（1.4）岁）活检证实肝硬化和顽固性腹水进行了肺和内脏血流动力学血管造影测量。从肺动脉测量内皮素1水平。49例患者接受了放射性核素血管造影术，用于测量中心血容量、肺血管和心腔容积。47例患者还接受了二维超声心动图测量心脏结构和功能参数。计算心输出量、体循环阻力和肺循环阻力。（16.1%）符合PPHTN标准（平均肺动脉压大于或等于25 mm Hg，肺血管阻力大于或等于120 dyn x s/cm（5）），平均右心房（15.4（1.2）v7.9（0.5）mm Hg; p< 0.001），右心室压力（24.7（1.5）v14.7（0.6）mm Hg; p< 0.001），内皮素1水平（3.04（0.40）v1.98（0.12）pg/ ml; p= 0.02）。两组之间未检测到任何其他测量参数的显著差异。右心房压力大于或等于14毫米汞柱有83%的阳性预测值存在PPHTN.Conclusions：门静脉高压症是常见的肝硬化顽固性腹水，可能是由于过量的内皮素1在肺循环。右心房压力升高大于或等于14 mm Hg预测PPHTN的存在，这可能有助于决定这些患者的治疗方案。
Background: The prevalence of portopulmonary hypertension (PPHTN) in patients with cirrhosis and refractory ascites is unknown. Its presence may preclude patients from receiving a transjugular intrahepatic portosystemic shunt or liver transplantation as a definitive treatment for their end stage cirrhosis.Purpose: To determine the prevalence, possible aetiological factors, and predictive factors for the development of PPHTN in these patients.Methods: Sixty two patients (53 males, nine females; mean age 54.5 (1.4) years) with biopsy proven cirrhosis and refractory ascites underwent angiographic measurements of pulmonary and splanchnic haemodynamics. Endothelin 1 levels were measured from the pulmonary artery. Forty nine patients underwent radionuclide angiography for measurements of central blood volume, pulmonary vascular, and cardiac chamber volumes. Forty seven patients also underwent two dimensional echocardiography for measurements of cardiac structural and functional parameters. Cardiac output, and systemic and pulmonary vascular resistance were calculated.Results: Ten patients ( 16.1%) fulfilled the criteria for PPHTN ( mean pulmonary artery pressure greater than or equal to 25 mm Hg and pulmonary vascular resistance greater than or equal to 120 dyn x s/cm(5)), with significantly higher mean right atrial (15.4 (1.2) v 7.9 (0.5) mm Hg; p< 0.001), and right ventricular pressures (24.7 (1.5) v 14.7 (0.6) mm Hg; p< 0.001), and endothelin 1 levels (3.04 (0.40) v 1.98 (0.12) pg/ ml; p= 0.02). No significant differences in any of the other parameters measured were detected between the two groups. A right atrial pressure of greater than or equal to 14 mm Hg had a 83% positive predictive value for the presence of PPHTN.Conclusions: Portopulmonary hypertension is common in cirrhosis with refractory ascites, possibly due to excess endothelin 1 in the pulmonary circulation. An elevated right atrial pressure greater than or equal to 14 mm Hg predicts the presence of PPHTN, which may be helpful in deciding management options in these patients.