AIM： To study the presence of sustained low diffusing capacity （DLco） after liver transplantation （LT） in patients with hepatopulmonary syndrome （HPS）. METHODS： Six patients with mild-to-severe HPS and 24 with...AIM： To study the presence of sustained low diffusing capacity （DLco） after liver transplantation （LT） in patients with hepatopulmonary syndrome （HPS）. METHODS： Six patients with mild-to-severe HPS and 24 without HPS who underwent LT were prospectively followed before and after LT at mid-term （median, 15 mo）. HPS patients were also assessed at Iong-tem （median, 86 mo）. RESULTS： Before LT, HPS patients showed lower PaO2 （71 ± 8 mmHg）, higher AaPO2 （43 ± 10 mmHg） and lower DLco （54% ± 9% predicted）, due to a combination of moderate-to-severe ventilation-perfusion （VA/Q） imbalance, mild shunt and diffusion limitation, than non- HPS patients （94 ± 4 mmHg and 19 ± 3 mmHg, and 85% ± 3% predicted, respectively） （P 〈 0.05 each）. Seven non-HPS patients had also reduced DLco （70% ± 4% predicted）. At mid- and long-term after LT, compared to pre- LT, HPS patients normalized PaO2 （91 ± 3 mmHg and 87 ± 5 mmHg）, AaPO2 （14 ± 3 mmHg and 23 ± 5 mmHg） and all VA/Q descriptors （P 〈 0.05 each） without changes in DLco （53% ± 8% and 56% ± 7% predicted, respectively）. Post-LT DLco in non-HPS patients with pre- LT low DLco was unchanged （75% ± 6% predicted）. CONCLUSION： While complete VA/Q resolution in HPS indicates a reversible functional disturbance, sustained low DLco after LT also present in some non-HPS patients, points to persistence of sub-clinical liver-induced pulmonary vascular changes.展开更多
目的回顾分析94例(肺通气功能正常)不同血红蛋白(hemoglobin,Hb)浓度受试者其Hb浓度对肺一氧化碳弥散量(diffusion capacity for carbon monoxide of the Lung,DLCO)的影响及对其Hb浓度进行校正的意义。方法将33例Hb>12 g/100 m L受...目的回顾分析94例(肺通气功能正常)不同血红蛋白(hemoglobin,Hb)浓度受试者其Hb浓度对肺一氧化碳弥散量(diffusion capacity for carbon monoxide of the Lung,DLCO)的影响及对其Hb浓度进行校正的意义。方法将33例Hb>12 g/100 m L受试者设为对照组,30例12 g/100 m L>Hb>9g/100 m L受试者设为A组,31例Hb<9 g/100 m L受试者设为B组;经肺功能仪测试获得3组Hb浓度校正前DLCO、DLCO实测值/预计值(B/P)及校正后DLCOc及DLCOc(B/P)。结果对照组及A组各组组内Hb浓度校正前后比较,DLCO与DLCOc及DLCO(B/P)与DLCOc(B/P)变化均不明显,差异无统计学意义;B组Hb浓度校正前后DLCO与DLCOc比较差异值为(1.09±0.21),而DLCO(B/P)与DLCOc(B/P)比较差异值为(16.64±2.99),差异有统计学意义(P<0.05);同时,将A组DLCO与DLCOc、DLCO(B/P)与DLCOc(B/P)Hb校正前后差异值与对照组比较(P<0.05),与B组比较,差异有统计学意义(P<0.05);此外,A、B 2组Hb浓度校正后,弥散功能损伤比校正前有不同程度改善,其中正常达标率分别提高36.7%和35.5%,差异有统计学意义(P<0.05)。结论 Hb浓度的下降可致DLCO不同程度降低,在对肺功能测试结果进行评价时除需排除其它因素对DLCO的影响外,还需要同时观察DLCO及DLCOc,以正确评估Hb浓度对DLCO的影响。展开更多
基金Supported by Red Respira-ISCIII-RTIC-03/11 and Generalitat de Catalunya, No. 2005SGR-00822
文摘AIM： To study the presence of sustained low diffusing capacity （DLco） after liver transplantation （LT） in patients with hepatopulmonary syndrome （HPS）. METHODS： Six patients with mild-to-severe HPS and 24 without HPS who underwent LT were prospectively followed before and after LT at mid-term （median, 15 mo）. HPS patients were also assessed at Iong-tem （median, 86 mo）. RESULTS： Before LT, HPS patients showed lower PaO2 （71 ± 8 mmHg）, higher AaPO2 （43 ± 10 mmHg） and lower DLco （54% ± 9% predicted）, due to a combination of moderate-to-severe ventilation-perfusion （VA/Q） imbalance, mild shunt and diffusion limitation, than non- HPS patients （94 ± 4 mmHg and 19 ± 3 mmHg, and 85% ± 3% predicted, respectively） （P 〈 0.05 each）. Seven non-HPS patients had also reduced DLco （70% ± 4% predicted）. At mid- and long-term after LT, compared to pre- LT, HPS patients normalized PaO2 （91 ± 3 mmHg and 87 ± 5 mmHg）, AaPO2 （14 ± 3 mmHg and 23 ± 5 mmHg） and all VA/Q descriptors （P 〈 0.05 each） without changes in DLco （53% ± 8% and 56% ± 7% predicted, respectively）. Post-LT DLco in non-HPS patients with pre- LT low DLco was unchanged （75% ± 6% predicted）. CONCLUSION： While complete VA/Q resolution in HPS indicates a reversible functional disturbance, sustained low DLco after LT also present in some non-HPS patients, points to persistence of sub-clinical liver-induced pulmonary vascular changes.
文摘目的回顾分析94例(肺通气功能正常)不同血红蛋白(hemoglobin,Hb)浓度受试者其Hb浓度对肺一氧化碳弥散量(diffusion capacity for carbon monoxide of the Lung,DLCO)的影响及对其Hb浓度进行校正的意义。方法将33例Hb>12 g/100 m L受试者设为对照组,30例12 g/100 m L>Hb>9g/100 m L受试者设为A组,31例Hb<9 g/100 m L受试者设为B组;经肺功能仪测试获得3组Hb浓度校正前DLCO、DLCO实测值/预计值(B/P)及校正后DLCOc及DLCOc(B/P)。结果对照组及A组各组组内Hb浓度校正前后比较,DLCO与DLCOc及DLCO(B/P)与DLCOc(B/P)变化均不明显,差异无统计学意义;B组Hb浓度校正前后DLCO与DLCOc比较差异值为(1.09±0.21),而DLCO(B/P)与DLCOc(B/P)比较差异值为(16.64±2.99),差异有统计学意义(P<0.05);同时,将A组DLCO与DLCOc、DLCO(B/P)与DLCOc(B/P)Hb校正前后差异值与对照组比较(P<0.05),与B组比较,差异有统计学意义(P<0.05);此外,A、B 2组Hb浓度校正后,弥散功能损伤比校正前有不同程度改善,其中正常达标率分别提高36.7%和35.5%,差异有统计学意义(P<0.05)。结论 Hb浓度的下降可致DLCO不同程度降低,在对肺功能测试结果进行评价时除需排除其它因素对DLCO的影响外,还需要同时观察DLCO及DLCOc,以正确评估Hb浓度对DLCO的影响。
