Hepatopulmoner sendrom tanisi konulan olgularin klinik özellikleri
The clinical characteristics of the patients with the diagnosis of hepatopulmonary syndrome
Atatürk Gögüs Hastaliklari ve Gögüs Cerrahisi Egitim ve Arastirma Hastanesi, Gögüs Hastaliklari Bölümü2, Ankara
Özet
Giris ve amaç: Hepatopulmoner sendrom (HPS), karaciger hastaligi, artmis alveolo-arteriyel oksijen gradiyenti (P(A-a) O2) ve intrapulmoner vasküler dilatasyon triadi ile karakterize bir klinik tablodur. Bu çalismada klinigimizde kronik karaciger hastaligi tanisi ile takip edilen hastalarda HPS insidansinin ve HPS’ye özgü klinik özelliklerinin ortaya konmasi amaçlanmistir. Gereç ve yöntem: Çalismaya ek kardiyopulmoner patolojisi olmayan 70 kronik karaciger hastasi alindi. Her hastada egzersiz sonrasi dönemde arteriyel kan gazi incelemesi yapildi. P(A-a) O2’si yüksek olanlara kontrast ekokardiyografi yapildi. Tüm olgularin Child skoru ve fizik muayene bulgulari degerlendirildi. Bulgular: Çalismaya ali- nan 70 hastanin 12’sine (%17) HPS tanisi kondu. HPS’li hastalarda parmaklarda çomaklasma ve spider nevi HPS’si olmayanlara göre anlamli düzeyde daha fazla görülmekteydi. Tüm semptom ve bulgularin tanisal duyarliliklari düsükken platipne, parmaklarda çomaklasma ve spider nevi’nin tanisal özgüllügü yüksekti. HPS’si olan (9,9±1,9) ve olmayan hastalari n (8,5±2,3) Child skorlari arasinda anlamli fark görülmedi. Child grubu A’dan C’ye dogru ilerledikçe HPS insidansinin arttigi gözlense de (Child A:%9,1, Child B:%12,5 ve Child C: %25,9) aradaki fark istatistiksel olarak anlamli bulunmadi. Sonuç: HPS kronik karaciger hastalari nda sik görülen bir klinik tablodur. Tüm semptom ve bulgularin tanidaki duyarliligi düsük olmakla beraber spider nevi, parmaklarda çomaklasma ve platipnenin tanisal özgüllügü yüksek bulunmustur.
Abstract
Background/aim: Hepatopulmonary syndrome (HPS) is a clinical entity characterized by the triad of liver disease, increased alveolar arterial oxygen gradient (P(A-a) O2) and intrapulmonary vascular dilatation. In this study we aimed to determine the incidence and the specific clinical characteristics of HPS in our patients with chronic liver disease. Materials and methods: Seventy chronic liver disease patients without any concomitant cardiopulmonary disease were enrolled into the study. Arterial blood gas analysis was performed after a period of exercise. Patients with a high P(A-a) O2 underwent contrast echocardiography. Child score and physical examination findings were evaluated in all patients. Results: Of 70 patients, 12 were diagnosed as HPS. Clubbing and spider nevi were significantly higher in HPS patients than in non-HPS patients. While the diagnostic sensitivities of all the symptoms and physical findings were low, the specificities of platypnea, clubbing and spider nevi were high. There was no significant difference between the Child score of HPS (9.9±1.9) and non-HPS (8.5±2.3) patients. Although the incidence of HPS was observed to be increased from Child A to C (Child A: 9.1%, Child B: 12.5%, Child C: 25.9%), the difference was not statistically significant. Conclusion: HPS is a common clinical entity in patients with chronic liver disease. While the diagnostic sensitivities of all the symptoms and physical findings were low, the specificities of clubbing, spider nevi, and platypnea were found to be high.
