Korean J Intern Med.  2001 Jun;16(2):56-61.

Hepatopulmonary Syndrome in Poorly Compensated Postnecrotic Liver Cirrhosis by Hepatitis B Virus in Korea

• Lee JH
• Lee DH
• Zo JH
• Kim TH
• Lee KL
• Chung HS
• Kim CH
• Han SK
• Sim YS
• Lee HS
• Yoon YB
• Song IS
• Kim CY

Abstract

BACKGROUND: Hepatopulmonary syndrome (HPS) refers to the association of hypoxemia, intrapulmonary shunting and chronic liver disease. But there is no clear data about the prevalence of HPS in postnecrotic liver cirrhosis by hepatitis B virus(HBV), the most common cause of liver disease in Korea. The aim of this study was to investigate the prevalence of HPS in poorly compensated postnecrotic liver cirrhosis by HBV, and the correlation of the hepatopulmonary syndrome with clinical aspects of postnecrotic liver cirrhosis by HBV. METHODS: Thirty-five patients underwent pulmonary function test, arterial blood gas analysis and contrast-enhanced echocadiography. All patients were diagnosed as HBV-induced Child class C liver cirrhosis and had no evidence of intrinsic cardiopulmonary disease. RESULTS: Intrapulmonary shunt was detected in 6/35 (17.1%) by contrast- enhanced echocariography. Two of six patients with intrahepatic shunts had significant hypoxemia (PaO2 < 70 mmHg) and four showed increased alveolar- arterial oxygen gradient over 20 mmHg. Only cyanosis could reliably distinguish between shunt positive and negative patients. CONCLUSIONS: The prevalence of intrapulmonary shunt in poorly compensated postnecrotic liver cirrhosis by HBV was 17.1% and the frequency of hepatopulmonary syndrome was relatively low (5.7%). 'Subclinical' hepatopulmonary syndrome (echocardiographically postive intrapulmonary shunt but without profound hypoxemia) exists in 11.4% of cases with poorly compensated postnecrotic liver cirrhosis by HBV. Cyanosis is the only reliable clinical indicator of HPS of HBV- induced poorly compensated liver cirrhosis. Further studies are required to determine if the prevalence and clinical manifestations of HPS varies with etiology or with geographical and racial differences.

Keyword

Hepatopulmonary syndrome; Contrast echocardiography; Liver cirrhosis; Hepatitis B virus

MeSH Terms

Adult
Aged
Analysis of Variance
Comorbidity
Female
Hepatitis B/diagnosis/*epidemiology
Hepatopulmonary Syndrome/diagnosis/*epidemiology
Human
Korea/epidemiology
Liver Cirrhosis/classification/*epidemiology
Male
Middle Age
Necrosis
Prevalence
Probability
Respiratory Function Tests
Risk Assessment