肝-肺综合征与蜘蛛痣及食管-胃底静脉曲张的关系

Relationship between hepatopulmonary syndrome,spider angioma and portol hypertension

目的研究肝硬化发生肝一肺综合征（HPS）与蜘蛛痣及低氧血症、门脉高压、食管－胃底静脉曲张、上消化道出血的关系。总结了55例肝硬化患者并与22例健康人作对照。方法55例肝硬化患者中除22例做了肺功能检查外，均做血气分析、肝功能、腹部B超及上消化道造影检查。结果肝硬化患者的肺功能和对照组比较有明显下降（P＜0．05～0．01）；蜘蛛痣阳性组肺功能和蜘蛛阳痣阴性组比较有明显下降（P＜0．05～0．01）；蜘蛛痣阳性组其低氧血症、门脉高压、上消化道出血的发生率明显高于蜘蛛痣阴性组（P＜0．05）；肝功能分级childC级患者肺功能明显低于ChildA、B级患者（P＜0．05～0．01）。结论肝－肺综合征可发生于肝硬化的任何阶段，不仅影响小血管和毛细血管，也累及中等度血管，特别是合并蜘蛛痣阳性的肝硬化患者，更应该警惕肝－肺综合征的发生。目前，肝移植被认为是有效的治疗方法。

In order to investigate the relationship between hepatopulmonary syndrome (HPS)and spider angioma, hypoxemia, potral hypertension, esophageal varices and uppergastrointestinal bleeding, 55 cases with cirrhosis of liver and 22 cases of healthy control werestudied. Tests such as blood gas analysis, liver function,B-mode ultrasound examination of theabdomen and upper gastrointestinal radiography were given to the cirrhosis of liver patients, while22 of them also had been undertaken the pulmonary function test. It showed that the level ofpulmonary function of the patients with cirrhosis of liver was much lower than the level of thecontrol group (P <0. 05~0. 01). The level of pulmonary function of the patients with the spiderangioma positive group was much lower than that of the spider angioma negative group (P <0. 05~0. 01 ). The incidence of hypoxemia and portal hypertension wsa much more common in thespider angioma positive group than that in the negative group (P < 0. 05). The level of thepulmonary function of those patients whose liver function was in child-C was much lower thanthose in child-A or child-B (P <0. 05). It is concluded that HPS can occur at any stage of cirrhosisof liver. It damaged not only the small blood vessels and sapillaries, but also the middle bloodvessels. Liver transplantation is considered as the useful treatment.