Печеночно-легочный синдром и особенности его проявлений при циррозе печени, сочетающемся с хронической обструктивной болезнью легких

Aim. To evaluate specific features of hepatopulmonary syndrome (HPS) in patients with cirrhosis and cirrhosis associated with chronic obstructive pulmonary disease (COPD).
Material and methods. We made a retrospective analysis of case histories of 75 patients with hepatic cirrhosis (HC) of different etiology. The patients were divided into two groups: 23 patients with HC and COPD (group 1); 52 patients with HC without COPD (group 2). The patients were examined with spirography, gasometry. Single-breath carbon monoxide diffusion capacity (Dlco), TCO and TCO/VA were estimated. Transthoracic contrast-enhanced echocardiography was conducted for detection of intrapulmonary bypass in AaDO2 > 15 mm Hg.
Results. COPD stage I and II were diagnosed in 14 of 23 and 9 of 23 patients of group 1, respectively. TCO and TCO/VA had a trend to lowering in group 1 (p > 0.05). PaO2 was lower (p < 0.05) while AaDO2 was higher (p < 0.05) in group 1. Four patients of group 1 had intrapulmonary bypasses: of the first degree (2 patients with hypoxemia) and of the first and second degree (2 patients with normoxemia). In group 2 three patients had intrapulmonary bypasses: of the fourth degree in 1 patient with hypoxemia and of the first and second degree in 2 patients with normoxemia.
Conclusion. HC patients with COPD had more severe hypoxemia. Mild and moderate HPS were registered in both groups. In COPD the risk of HPS is 3 times higher.

chronic obstructive pulmonary disease, hepatic cirrhosis, hepatopulmonary syndrome, intrapulmonary vasodilation, intrapulmonary bypass