Aydın Şeref KÖKSAL, Deniz KÖKSAL, Sabite KACAR, Omaç TÜFEKÇİOĞLU, Nurgül ŞAŞMAZ

Hepatopulmoner sendrom tanısı konulan olguların klinik özellikleri

Giriş ve amaç: Hepatopulmoner sendrom (HPS), karaciğer hastalığı, artmış alveolo-arteriyel oksijen gradiyenti (P(A-a) O2) ve intrapulmoner vasküler dilatasyon triadı ile karakterize bir klinik tablodur. Bu çalışmada kliniğimizde kronik karaciğer hastalığı tanısı ile takip edilen hastalarda HPS insidansının ve HPS'ye özgü klinik özelliklerinin ortaya konması amaçlanmıştır. Gereç ve yöntem: Çalışmaya ek kardiyopulmoner patolojisi olmayan 70 kronik karaciğer hastası alındı. Her hastada egzersiz sonrası dönemde arteriyel kan gazı incelemesi yapıldı. P(A-a) O2'si yüksek olanlara kontrast ekokardiyografi yapıldı. Tüm olguların Child skoru ve fizik muayene bulguları değerlendirildi. Bulgular: Çalışmaya alınan 70 hastanın 12'sine (%17) HPS tanısı kondu. HPS'li hastalarda parmaklarda çomaklaşma ve spider nevi HPS'si olmayanlara göre anlamlı düzeyde daha fazla görülmekteydi. Tüm semptom ve bulguların tanısal duyarlılıkları düşükken platipne, parmaklarda çomaklaşma ve spider nevi'nin tanısal özgüllüğü yüksekti. HPS'si olan (9,9±1,9) ve olmayan hastaları n (8,5±2,3) Child skorları arasında anlamlı fark görülmedi. Child grubu A'dan C'ye doğru ilerledikçe HPS insidansının arttığı gözlense de (Child A:%9,1, Child B:%12,5 ve Child C: %25,9) aradaki fark istatistiksel olarak anlamlı bulunmadı. Sonuç: HPS kronik karaciğer hastalarında sık görülen bir klinik tablodur. Tüm semptom ve bulguların tanıdaki duyarlılığı düşük olmakla beraber spider nevi, parmaklarda çomaklaşma ve platipnenin tanısal özgüllüğü yüksek bulunmuştur.

Anahtar Kelimeler:

Hepatopulmoner sendrom, karaciğer, klinik

The clinical characteristics of the patients with the diagnosis of hepatopulmonary syndrome

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.

Keywords:

Hepatopulmonary syndrome, liver, clinic,

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