HBV肝硬化失代偿期门脉性肺动脉高压发生率及危险因素分析

Prevalence and risk factors of portopulmonary hypertension in patients with HBV-decompensated cirrhosis

目的探讨HBV-肝硬化失代偿期患者门脉型肺动脉高压症(POPH)的发生率及危险因素。方法本研究共有298例HBV感染并经活检证实肝硬化的患者入组。POPH诊断标准为同时满足以下两条:1)通过心脏多普勒测量肺动脉收缩压(PASP)≥40mm Hg;2)经计算机断层扫描(CT)测量主肺动脉和升主动脉直径比率(RPA)>1。收集重要的临床参数用于评估影响POPH发展的潜在危险因素。结果POPH在HBV肝硬化失代偿期的患者中发生率为20.47%。单因素分析显示,相比于非POPH组,POPH组患者年龄、顽固性腹水、原发性腹膜炎、PT、凝血酶原活动度、胆红素水平、MELD评分、Child-Pugh分级和脾脏厚度的差异均有统计学意义(P值均<0.05)。多因素分析显示,年龄较大的患者POPH发病率低(OR=0.96,P=0.001),有顽固性腹水的患者POPH发病率高(OR=4.7,P<0.001)。结论本研究结果可用于肝移植患者术前早期发现POPH。

Objective To investigate the prevalence and risk factors of portopulmonary hypertension（POPH）in patients with HBV-decompensated cirrhosis.Methods A total of 298 HBV infection patients with biopsy proven cirrhosis were analyzed retrospectively.The criterion of POPH diagnosis was：1）the pulmonary artery systolic pressure（PASP）≥40mm Hg,measured by cardiac Doppler echography,and 2）the ratio between the internal diameters of main pulmonary artery and ascending aorta（rPA）1,calculated by computed tomography（CT）scan.Several important clinical parameters were collected to evaluate the potential risk factors for POPH development.Results The prevalence of POPH in patients with HBV-decompensated cirrhosis was 20.47%.In the univariable analyses,compared to the non-POPH group,the POPH group had an older age（P=0.003）,a higher incidence of refractory ascites and primary peritonitis,a longer prothrombin time,a lower prothrombin activity,a higher total bilirubin level,a higher MELD scores,a higher Child-Pugh classification,and a thicker spleen（all P〈0.05）.However,the multivariable analysis of above significant variables indicated that older patients had a lower risk for POPH（OR=0.96,P=0.001）,and the patients with refractory ascites were at a higher risk for POPH（OR=4.7,P〈0.001）.Conclusion Our result could be used to detect POPH early for liver transplant candidates in preoperative period.