肝硬化失代偿期患者肝储备功能与动脉血氧相关性研究

[目的]探讨肝硬化失代偿期患者动脉血氧分压（PaO2）、氧饱和度（SaO2）和二氧化碳分压（PaCO2）的变化,评价动脉血氧在肝肺综合征（HPS）临床诊断中的价值,为诊断和预防HPS提供理论依据。[方法]应用血气分析仪测定60例肝硬化失代偿期患者（肝硬化组）及同期住院60例非肝硬化失代偿者（对照组）,比较2组的PaO2、SaO2、PaCO2。并比较肝硬化组Child-Pugh为A、B、C间的PaO2、SaO2、PaCO2。[结果]肝硬化组患者低氧血症发生率为48%。①肝硬化组PaO2与对照组PaO2比较P〈0.01,而肝硬化组和对照组SaO2、PaCO2值水平比较差异无统计学意义（P〉0.05）;②肝硬化Child-Pugh A、B、C 3级间PaO2,SaO2值比较差异有统计学意义（P〈0.01）,而3级间PaCO2水平比较差异无统计学意义（P〉0.05）,且PaO2、SaO2值随着Child-Pugh分级的增高呈下降趋势。[结论]肝硬化患者低氧血症发生率高,其发生率随着Child-Pugh分级的增高而呈梯形上升。血气分析对HPS有诊断价值。     

肝炎后肝硬化患者肺功能和动脉血氧变化的研究

目的:研究肝炎后肝硬化患者的肺功能和动脉血氧改变的关系。方法:用单筒肺量计检测肺功能,用血气分析仪测定动脉血氧水平。结果:肺功能检测各项参数IC、ERV、VC、PV、PRV、MBC、FEV肝硬化组均明显低于对照组(慢性胃炎),肺功能减退发生率为68.42％。动脉PaO_2、CaO_2、SaO_2也明显低于对照组,异常检出率为47.37 ％。本组结果显示肺功能减退与低氧血症发生不成正比,表明肝炎后肝硬化患者的低氧血症,其肺功能减低不是唯一的主导因素。     

肝肺综合征的临床特点及诊断

目的探讨肝肺综合征(HPS)的临床特点及诊断方法,提高对其认识.方法回顾性分析我院1986年1月～2003年12月确诊的13例患者的临床资料.结果除1例为慢性酒精性肝损害基础上的急性药物性肝炎外,12例均为肝硬化患者,据Child-Pugh分级标准,肝功能B级和C级者11例(84.60%);平均动脉血氧分压(PaO2)为6.94±1.5 kPa,10例中9例直立位缺氧大于10%.临床主要表现为呼吸困难(100%)、紫绀(100%)、杵状指(84.6%)、肝掌(84.6%)、面部毛细血管扩张(84.6%)、蜘蛛痣(69.2%).9例行肺功能检查患者中8例为弥散功能障碍.所有患者均经99mTc标记的人血白蛋白聚合颗粒(99mTc-MAA)首次通过肺灌注显像确诊,测定肺内分流率为22%～57%.11例同时计算吸入100%氧气时动静脉分流占总血流量百分比(Qs/Qt)的结果为10.9%～27.4%,均小于前者所得.结论肝肺综合征的发生与肝功能不全和门脉高压症都有关系,同时有门静脉高压、紫绀、杵状指、蜘蛛痣或面部毛细血管扩张时应考虑该诊断.直立位缺氧(>10%)为典型表现,99mTc-MAA首次通过肺灌注显像是有效的诊断方法,所测定的肺内分流率大于Qs/Qt.     

肝炎后肝硬化患者血浆胰高血糖素水平的变化及其临床意义

目的　了解肝炎后肝硬化患者血浆胰高血糖素水平变化及其与肝功能损害程度以及与门脉高压的相关性。方法　采用放射免疫分析法测定３８ 例肝炎后肝硬化患者空腹血浆胰高血糖素水平。用Ｂ超测定门脉主干内径。结果　肝硬化患者血浆胰高血糖素水平显著高于正常组（ Ｐ＜ ０－０１），胰高血糖素浓度与门脉直径呈正相关（ｒ＝ ０－３９３， Ｐ＜ ０－０５），而与肝功能损害程度无明显相关。结论　胰高血糖素可能在门脉高压的形成与维持中起重要作用     

肝硬化患者植物神经功能和低氧血症变化的关系探讨

目的探讨肝硬化患者植物神经功能和低氧血症变化的关系.方法以综合指标测定法测定30例肝硬化患者的植物神经功能并抽动脉血检测动脉血氧分压.结果按Child-Pugh分级,在植物神经功能测定中,B级13例,正异常值0例,正常值8例,负异常值5例,异常率为38.46%;C级17例,正异常值1例,正常值6例,负异常值10例,异常率为64.71%.说明植物神经功能损害与肝脏损害呈正相关.在动脉血氧分压测定中,B级轻度低氧血症6例,中度低氧血症5例,重度低氧血症2例;C级轻度低氧血症0例,中度低氧血症5例,重度低氧血症12例.B级和C级两组间比较差异有显著性（P＜0.005）.结论多数肝硬化患者植物神经功能和低氧血症异常与肝脏功能损害呈相关性.     

66例肝硬变患者的血氧变化

目的:了解肝炎后肝硬变患者的动脉血氧水平并探讨其临床意义。方法:应用自动血气分析仪检测66例肝炎后肝硬变患者和20例正常人的动脉血氧分压、血二氧化碳分压及血氧饱和度。结果:肝硬吏患者的动脉血氧分压为10.55±2.61kPa,明显低于正常人(P<0.05)。低氧血症发生率为56.0％(37/66),与腹水、门静脉增宽、皮肤蜘蛛痣及肝贮备功能降低密切相关,好发于并发急性上消化道出血、肝性脑病,肝肾综合征和自发性腹膜炎的患者。结论:动脉血氧水平检测有助于肝硬变的预后判断。     

21例肝肺综合征临床分析

肝肺综合征（hepatopulmonary syndrome，HPS）指慢性肝功能不全患者因肺内血管扩张而出现严重低氧血症，是各种慢性肝脏疾病终末期的一种严重并发症，预后差。HPS近年来引起广泛重视，其三联征为肝功能不全、肺血管扩张和低氧血型引。我院2003年5月至2008年5月对收治61例肝硬化患者进行血气分析等检测发现21例HPS,     

23例肝肺综合征临床分析

探讨肝肺综合征(HPS)的临床特点和预后。67例肝硬化患者均应用血气分析仪测定其动脉血氧分压(PaO2),其中Ch ild-Pugh分级A级30例,B级22例,C级15例。67例肝硬化患者中23例合并HPS,发病率为34.3%。其发病率与Ch ild-Pugh分级有关,与A级比较C级HPS,发病率显著增高(P<0.05);门静脉增宽与不宽者、胃底食管静脉曲张与未发现曲张者、有蜘蛛痣与无蜘蛛痣者分别合并有HPS,两者比较均差异有显著性(P<0.05)。23例HPS患者中7例死亡,HPS均不是直接死亡原因。有门脉高压、蜘蛛痣时提示HPS的存在。早期诊断和治疗有助于缓解低氧血症,改善预后。     

肝硬化患者中的肺血管异常

发病机制及主要研究进展目前研究发现,肝脏及门脉系统是肺循环及体循环中调节血管反应及新生微血管形成的主要场所[1]。门脉性肺动脉高压(POPH)和肝肺综合征(HPS)都是在肝脏疾病或门脉高压基础上,肺部微循环中非正常微血管形成的结果。POPH主要发生于肺动脉段,其病理生理学基础与其他肺动脉高压相似,主要由于肺动脉段的血管内皮及平滑肌细胞的增生与纤维化导致的管腔阻塞,从而引起的血管阻力增高,肺     

肝硬变患者血氧变化临床分析及其机制探讨

目的探讨肝硬变患者血氧变化及其发生机制．方法肝硬变患者６６例,应用血气分析仪测定其动脉血氧分压（ＰａＯ２）及氧饱和度（ＳａＯ２）,其中肝炎后肝硬变６２例,酒精性肝硬变１例,血吸虫性肝硬变１例,原因不明肝硬变２例,肝功能ＣｈｉｌｄＡ级８例,Ｂ级３５例,Ｃ级２３例．选择同期１４例正常人作对照．结果肝硬变组平均ＰａＯ２为１１１３ｋＰａ±０１９ｋＰａ,ＳａＯ２为９７２２％±０１５％,正常对照组动脉血ＰａＯ２为１３１３ｋＰａ±０３６ｋＰａ,ＳａＯ２为９８０７％±０２５％,两者比较差异明显（Ｐ＜００１）．肝硬变患者ＰａＯ２,ＳａＯ２降低与门静脉内径,蜘蛛痣有关,与肝功能Ｃｈｉｌｄ分级,ＡＬＴ,胆碱酯酶无关,也与胸腔积液无关．结论肝硬变存在低氧血症,发生主要在于肺内血管扩张．     

Hemodynamic features and impaired arterial oxygenation in patients with portopulmonary hypertension.

Portopulmonary hypertension (P-PHT) is sporadically found in cirrhosis patients who have portal hypertension. We retrospectively investigated the clinical features of six patients with P-PHT and compared their hemodynamics and arterial oxygenation with data from 60 cirrhosis patients without pulmonary hypertension (non-PHT cirrhosis) admitted to our department. The mean pulmonary artery pressure and pulmonary vascular resistance index of P-PHT patients ranged from 25 to 57mmHg and from 399 to 1405dynesscm(-5)m(-2), respectively, and their arterial oxygenation was impaired. The systemic vascular resistance and cardiac index of P-PHT patients were similar level to those of patients with non-PHT cirrhosis. We found 10 patients with non-PHT cirrhosis in whom pulmonary vascular resistance exceeded the critical level for pre-capillary pulmonary hypertension (120dynesscm(-5)). These patients showed a distinctive hemodynamic profile, including a decrease of cardiac output due to contraction of the plasma volume and resultant elevation of systemic vascular resistance. However, the decrease of cardiac output contributed little to the elevation of pulmonary vascular resistance. Our findings suggested that certain factor(s) were acting to raise pulmonary vascular tone in these patients, which might cause chronic damage to the pulmonary vascular bed, leading to the onset of pulmonary hypertension.     

超声检查诊断肝硬化门静脉高压症临床价值研究

目的 研究超声检查在肝硬化门静脉高压症诊断中的临床价值。方法 选择2008年1月~2015年9月我院诊治的肝硬化门静脉高压症患者80例和体检健康者75例,使用纤维内镜进行胃镜检查,判断食管胃底静脉曲张程度,使用意大利百胜Mylab60全数字化多普勒超声诊断仪测量门静脉内径、脾静脉内径、门静脉血流量和脾静脉血流量。结果 肝硬化患者门静脉内径、脾静脉内径、门静脉血流量和脾静脉血流量分别为（1.4±0.6） cm、（1.2±0.3） cm、（1023.2±653.4） mL/min和（593.3±112.3） mL/min,均明显高于健康人【（0.9±0.2） cm、（0.6±0.4） cm、（916.3±254.2） mL/min和（325.6±96.4） mL/min,P<0.05】;46例门静脉内径≥1.4 cm组轻度曲张发生率为19.6%,明显低于34例门静脉内径<1.4 cm组的52.9%（P<0.05）,门静脉内径≥1.4 cm组重度曲张发生率为52.2%,明显高于门静脉内径<1.4 cm组的20.6%（P<0.05）;49例脾静脉内径≥1.0 cm组轻度曲张发生率为20.4%,明显低于31例脾静脉内径<1.0 cm组的51.6%（P<0.05）,脾静脉内径≥1.0 cm组重度曲张发生率为51.0%,明显高于脾静脉内径<1.0 cm组的22.6% （P<0.05）。结论 超声检查诊断肝硬化门静脉高压症具有较高的敏感性和特异性,对食管胃底静脉曲张的轻重程度也具有良好的诊断价值,能为评价患者的肝功能和选择治疗方案提供重要的参考依据。     

Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care

BACKGROUND Hepatic encephalopathy(HE) is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50% of cirrhotic patients. Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.AIM To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care.METHODS All patients hospitalised with HE requiring Rifaximin to 3 tertiary centres over46-mo(2012–2016) were identified via pharmacy dispensing records. Patients with hepatocellular carcinoma and those prescribed Rifaximin prior to admission were excluded. Medical records were reviewed to determine baseline characteristics and survival. The Kaplan-Meier method was used to calculate survival probability. Univariate survival analysis was performed with variables reaching statistical significance included in a multivariate analysis. The primary outcome was 12-mo mortality following commencement of Rifaximin.RESULTS188 patients were included. Median age was 57 years(IQR 50-65), 71% were male and median model for end stage liver disease and Child Pugh scores were 25(IQR 18-31) and 11(IQR 9-12) respectively. The most common causes of cirrhosis were alcohol(62%), hepatitis C(31%) and non-alcoholic fatty liver disease(20%).A precipitating cause for HE was found in 92% patients with infection(43%), GI bleeding(16%), medication non-compliance(15%) and electrolyte imbalance(14%) the most common. During a mean follow up period of 12 ± 13 mo 107(57%) patients died and 32(17%) received orthotopic liver transplantation. Themost common causes of death were decompensated chronic liver disease(57%)and sepsis(19%). The probability of survival was 44% and 35% at 12-and 24-mo respectively. At multivariate analysis a model for end stage liver disease 15 and international normalised ratio reached statistical significance in predicting mortality.CONCLUSION Despite advances made in the management of HE patients continue to have poor survival. Thus, in all patients presenting with HE the appropriateness of orthotopic liver transplantation should be considered.     

Haemodynamic and renal effects of tadalafil in patients with cirrhosis

A recent report introduced the phosphodiesterase-5 inhibition by vardenafil as a novel treatment of portal hypertension in patients with cirrhosis.In the herein presented"letter to the editor",the administration of tadalafil did not influence portal haemodynamics but impaired systemic haemodynamics in patients with cirrhosis.Our observations concur with the results of a report in a previous issue of World Journal of Gastroenterology(October 2008).Moreover,tadalafil adversely affected renal function in patients with decompensated liver disease.     

Plasma endothelin levels in patients with cirrhosis and their relationships to the severity of cirrhosis and renal function

Background/Aims: Increased plasma endothelin levels have been reported in patients with cirrhosis. However, the relationship between plasma endothelin concentrations and hyperdynamic circulation or renal functions has not been documented.Methods: We measured the plasma endothelin-1 and endothelin-3 concentrations using radioimmunoassay in 96 patients with cirrhosis (Pugh's A in 26, Pugh's B in 45 and Pugh's C in 25) and compared these values to 56 age- and sex-matched healthy subjects. Systemic and portal hemodynamic measurements, effective renal plasma flow, creatinine clearance, plasma aldosterone concentration and plasma renin activity were recorded for each patient.Results: Plasma endothelin-1 and endothelin-3 levels were significantly increased in patients with cirrhosis compared to healthy subjects. Additionally, plasma endothelin-1 and endothelin-3 values were higher in patients with cirrhosis and ascites than in those without ascites. Moreover, plasma endothelin-1 levels increased in relation to the severity of cirrhosis. On the other hand, modest negative correlations were found betwen endothelin-1 and creatinine clearance or effective renal plasma flow.Conclusions: Plasma endothelin-1 and endothelin-3 levels are increased in patients with cirrhosis compared to healthy subjects. The increase in plasma endothelin-1 levels is related at least in part to the severity of cirrhosis. Increased endothelin-1 levels may possibly contribute to renal dysfunction in patients with cirrhosis.     

肝硬化门静脉血栓形成的临床分析

目的　探讨肝硬化 (LC)门静脉血栓 (PVT)形成对LC病程发展的影响。方法　检索我院自 1 995至 2 0 0 2年肝硬化PVT形成患者 ,血栓诊断依据彩色多普勒和 (或 )CT。 4 8例肝硬化PVT形成患者入选血栓组 ;同阶段LC门脉高压症的非血栓病例中选择 5 2例作为对照组。对两组患者的肝功能Child Pugh分级、凝血功能、门静脉、脾静脉宽度及脾脏面积、厚度进行比较。行t检验 ,χ2 检验 ,Logistic回归分析。结果　肝硬化PVT形成除继发于脾切除等手术后 ,75 .0 %隐匿发病 ,85 .4 %的血栓发生于门静脉主干 ,脾脏增大与门静脉增宽是PVT形成的危险因素 (P =0 .0 0 3、0 .0 1 0 )。血栓组门静脉及脾静脉宽度分别为 (1 .4 8± 0 .2 6 )cm ,(1 .2 3± 0 .38)cm ,与对照组比较差异有显著性 [(1 .37± 0 .2 2 )cm ,(1 .0 5± 0 .30 )cm ,P =0 .0 37,0 .0 31 ]。血栓组脾面积平均值为 (96 .6 4± 33.4 )cm2 ,脾厚径为 (6 .0 7± 1 .2 0 )cm ,分别大于对照组的 (80 .81± 2 8.9)cm2 ,(5 .2 3± 1 .0 8)cm(P =0 .0 36 ,0 .0 0 1 )。血栓组食管胃底静脉曲张程度重于非血栓组 ,大出血、大量腹水比例高 (P <0 .0 5 )。血栓形成后 1年内死亡率为1 6 .6 % ,较非血栓组增高 (P =0 .0 2 3)。两组肝功能Child Pugh分级、凝血功能、血小板计     

超声联合剪切波弹性成像技术在病毒性肝炎后肝硬化门静脉高压中的应用研究

目的评估超声联合剪切波弹性成像(SWE)技术在肝硬化门静脉高压中的临床应用价值。方法选取病毒性肝炎后肝硬化门静脉高压患者64例,门静脉压力(PVP)测定前超声测量门静脉和脾静脉血流参数;采用SWE技术检测获得肝脏和脾脏硬度指标组织剪切波传播速度(SWV);分析门静脉和脾静脉血流参数、肝功能、肝脏和脾脏SWV与PVP的相关性。结果肝功能Child-Pugh A级14例,B级43例,C级7例,平均肝脏SWV:C级(2.10±0.30)m/sB级(1.87±0.25)m/sA级(1.71±0.14)m/s。Spearman相关分析显示,门静脉内径、门静脉充血指数及脾脏SWV与PVP相关。多元回归分析显示,脾脏SWV为PVP的独立相关因素(t=7.493,P0.001);而门静脉和脾静脉血流参数、肝功能、肝脏SWV与PVP无明显相关性。结论脾脏SWV与PVP存在较好的相关性,SWE技术测定脾脏SWV将可能成为无创性评估肝硬化门静脉高压的重要方法。     

Relationship between retinopathy and cirrhosis

AIM: To evaluate ophthalmic disorders with special attention to retinopathy in cirrhotic patients. Vitamin A deficiency-related ophthalmopathy, xerophthalmia, and color blindness may be documented in cirrhosis due to various etiologies. Retinopathy is an obscure feature of cirrhosis. METHODS: Thirty-two cirrhotic patients, who were followed up by Clinics of Gastroenterology, Izmir Ataturk Teaching and Research Hospital, were enrolled to the study. Associated systemic diseases such as diabetes mellitus and hypertension were excluded. Thirty-two healthy volunteers took part as the control subjects. All participants had ophthalmologic examination in the same hospital. RESULTS: Five (15.6%) of the cirrhotic subjects had soft exudate in the retina. None of the control subjects had retinopathy (P<0.05). Intraocular pressure (IOP) measured for both eyes were also significantly lower in the cirrhotics (P<0.05 vs P= 0.01). There were no statistically significant differences between the two groups in terms of other ophthalmic pathologies. The ophthalmic findings did not show up any differences according to the etiology of cirrhosis. CONCLUSION: Soft exudates may develop in cirrhotic patients probably due to loss of synthetic function of liver and hemodynamic effects of portal hypertension. Retinopathy must be sought in cirrhosis because of its severe morbidity.