Study of HIF-1α,iNOS and hemodynamic in patients with hepatopulmonary syndrome with portal hypertension / 中国基层医药

Objective To investigate the relationship between the color doppler sonography and contrast-enhanced echocardiography(CEE)in assessment of intrapulmonary shunting in patients with hepatopulmonary syndrome and HIF-1α,iNOS and portal hemodynamic.Methoods To examine the portal vein diameter and blood flow velocity by color Dop-pler,and intrapulmonary shunting by contrast-enhanced echocardiography(CEE).The expressions of HIF-1α and iNOS in serum were determined by ELISA in the normal,hepatocirrhosis amalgamating HPS and unamalgamating HPS separately.Comparison of HIF-1α and iNOS in plasma was carried out and relationship between the portal hemodynamic and the intra-pulmonary shunting was examined in three groups.Results The levels of HIF-1α and iNOS in hepatocirrhosis amalgamating HPS were higher than those in unamalgamating HPS,the diameter of portal vein dilated and the velocity of portal vein dropped,there was correlation(P＜0.05).There were positive correlation with intrapulmonary shunting.Conclusion The color doppler sonography and contrast-enhanced echocardiography (CEE)which reflected HIF-1α,iNOS and the hemodynamic played an role in developing of HPS,and was available to early examine change of intra-pulmonary vessel.

A Case of Hepatopulmonary Syndrome Due to Intrapulmonary Shunting in a Patient with Liver Cirrhosis / 대한내과학회지

The hepatopulmonary syndrome is defined as the triad of liver disease, an increased alveolar-arterial gradient while breathing room air, and evidence of intrapulmonary dilatation. Other cardiopulmonary abnormalities(such as pleural effusion or decreased lung volumes) are common and may coexist in patients with the hepatopulmonary syndrome. An abnormal dilatation of intrapulmonary capillaries is evidenced by Tc 99m-MAA perfusion scan, contrast-enhanced echocardiography, and pulmonary angiography. We have experienced a case of hepatopulmonary syndrome in a fi7 year old woman with liver cirrhosis who complained of severe dyspnea and cyanosis. Her arterial blood gas analysis (ABGA) showed severe hypoxemia(PaO2 59mmHg), suggesting the hepatopulmonary syndrome, which was confirmed with the contrast-enhanced echocardiography. It showed delayc4 opacification of left side chambers during agitated saline injection', thus, intrapulmonary shunt was confirmed. So we report a case of hepatopulmonary syndrome with a rewiew of literature.

Hypoxemia In Liver Cirrhosis And Intrapulmonary Shunt Determination Using Tc-99m-MAA Whole Body Scan / 결핵

BACKGROUND: It is well known that severe hypoxemia is often associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Pulmonary vascular impairments, more specifically, intrapulmonary shunting have been considered as a major mechanism. Intrapulmonary shunting arises from pulmonary vascular dilatation at the precapillary level or direct arteriovenous communication and has relationship with the characteristic skin findings of spider angioma. However, these results are mainly from Western countries where alcoholic and primary biliary cirrhosis are dominant causes of cirrhosis. It is uncertain that tie same is true in viral hepatitiss associated liver cirrhosis, which is dominant causes of liver cirrhosis in Korea. We investigated the incidences of hypoxemia and orthodeoxia in Korean cirrhotic patients dominantly composed of postnecrotic cirrhosis and the significance of intrapulmonary shunting as the suggested mechanism of hypoxemia. METHOD: We performed the arterial blood gas analysis separately both at the supine and errect position in 48 stable cirrhotic patients without the evidences of severe complications such as ascites, variceal bleeding, and hepatic coma. According to the results of arterial blood gas analysis, all patients were divided into hypoxemic and normoxemic group. In each group, pulmonary function test and Tc-99m-MAA whole body scan were performed. The shunting fraction was calculated based on the fact that the sum of cerebral and bilateral renal blood flow is 32% of the systemic blood flow. RESULTS: The hypoxemia of PaO2 less than 80 mmHg was observed in 9 patients(18.8%) and Orthodeoxia more than 10 mmHg was observed in 8 patients(16.7%). Hut there was no patient with significant hypoxemia of PaO2 less than 60 mmHg. PaO2 was significantly decreased in the patients with spider angioma than the patients without spider angioma and showed no correlation with the serologic type and severities of liver function test findings. Any parameters of pulmonary function test did not demonstrate the difference between normoxemic and hypoxemic group. But hypoxemic group showed significantly increased shunt fraction of 11.4+/-4.1% than normoxemic group of 4.1+/-2.0% (p<0.05). CONCLUSIONS: Hypoxemia is not infrequently observed complication in liver cirrhosis and intrapulmonary shunting is suggested to play a major role in the development of hypxemia. But there was no great likelihood of clinically significant hypoxemia in our domestic cirrhotic patients predominantly composed of postnecrotic type.