Síndrome hepatopulmonar / Hepatopulomonar syndrome

RESUMO

Introdução: a síndrome hepatopulmonar (SHP), caracterizada pela tríade de doença hepática, hipoxemia e comunicações arteriovenosas intrapulmonares (CAVI), é considerada uma indicação para o transplante hepático. Nosso objetivo é avaliar a prevalência da SHP no nosso meio. Métodos: avaliamos 40 pacientes com cirrose, sem doença cardiopulmonar, nos quais realizamos gasometria arterial com o paciente em repouso e respirando em ar ambiente e a pesquisa de CAVI pela ecocardiografia com contraste (ECC). Resultados: a SHP foi encontrada em 9/40 (22,5%) e em 10/40 (25,0%), e embora houvesse a presença de CAVI, os mesmos não apresentavam hipoxemia, assim como em 4/40 (10,0%) observamos hipoxemia sem a presença de CAVI. Os pacientes foram divididos em grupo A, com 9 (22,5%) pacientes portadores da SHP, sendo 5 (55,6%) masculinos com a média de 48,2 ± 8,5 anos; e grupo B, 31 (77,5%) pacientes sem SHP, 18 (58,1%) masculinos com média 48,7 ± 12,6 anos (p>0,05). Os pacientes do grupo A apresentavam maior hipoxemia (PaO2 = 73,3 ± 7,3mmHg e gradiente alvéolo-arterial de oxigênio de 34,5 ± 11,9mmHg) quando comparados com os do grupo B (91,8 ± 8,6mmHg e 10,1 ± 8,8mmHg) (p<0,0001). Conclusão: nossos achados sugerem que a SHP é comum nos cirróticos (22,5%). E que nessa população a hipoxemia é multifatorial.

ABSTRACT

Introduction: the hepatopulmonary syndrome (HPS), characterized by the triad of liver disease, hypoxemia and intrapulmonary arteriovenous communications (IAVC), is considered a guidemark for liver transplantation. Our goal is to assess the prevalence of HPS in our midst. Methods: we evaluated 40 patients with cirrhosis without cardiopulmonary disease, in which we performed arterial blood gases analysis with the patient at rest breathing room air and researched IAVC submitting them to contrast echocardiography (CEC). Results: the HPS was found in 9/40 (22.5%) and in 10/40 (25.0%), although there was the presence of IAVC, they did not have hypoxemia. Just as in 4/40 (10.0%) we observed the presence of hypoxemia without IAVC. Patients were divided into Group A, represented by 9 (22.5%) patients with HPS, in which 5 (55.6%) were male with an average of age of 48.2 ± 8.5 years old. Group B was composed by 31 (77.5%) patients without HPS, in which 18 (58.1%) of them were male with an average of age of 48.7 ± 12.6 years old (p>0.05). Patients in group A had greater hypoxemia (PaO2 = 73.3 ± 7.3mmHg and alveolar-arterial gradient of oxygen = 34.5 ± 11.9mmHg) compared with group B (91.8 ± 8, 6mmHg and 10.1 ± 8.8mmHg) (p<0.0001). Conclusion: our fi ndings suggest that HPS is common in cirrhotic patients (22.5%). And that hypoxemia in this population is multifactorial.