HBV 에 의한 후괴사성 간경화환자들에서 조영 심초음파도를 이용한 폐내 단락에 관한 연구

Background: Liver cirrhosis is a common disease and mainly postnecrotic by the infection of hepatitis B virus (HBV) in Korea, and arterial hypoxemia is not a rare finding in liver cirrhosis. But there were few studies about hepatopulmonary syndrome which is defined as liver dysfunction, hypoxemia and intrapulmonary vascular dilatation, and one of the causes of arterial hypoxemia. Method: We examined the presence of dyspnea and stigmata of chronic liver disease in 35 patients who were diagnosed as Child class C, liver cirrhosis by HBV and had no evidence of intrinsic cardiopulmonary disease at Seoul Municipal Boramae Hospital (from January 1996 to October 1996). To diagnose hepatopulmonary syndrome, contrast-enhanced echocardiography was done for detecting intrapulmonary shunt in association with pulmonary function test, arterial blood gas analysis, chest roentgenogram and EKG. Result: 1) Twenty nine patients (82.9%) complained of exertional dyspnea, and the six from these patients also complained of resting dyspnea. Tachypnea was observed in 15 patients (42.9%/normal respiration rate defined as 12 to 16 per min), while platypnea was not found. 2) Splenomegaly and ascites were universal findings in all while clubbing of finger and cyanosis were observed in only 1 case (2.9%) and 2 cases (5.7%), respectively, and esophageal varix was found in the thirty two (91.4% / grade I in 9, grade II in 20 and grade III in 3 patients). Spider angioma was observed in the twenty one (70.0% among 30 patients). 3) Seven patients (20.0%) showed mild ventilatory defect of restrictive type since forced vital capacity decreased to 65-79% of predicted value. Diffusing capacity for carbon monoxide decreased below 70% of predicted value in 4 patients (11.4%). In addition, there were small amount of pleural effusion in 5 patients (14.3%) and nonspecific arrhythmia in 3 patients (8.6%). 4) Six cases (17.1%) had intrapulmonary shunt, which showed significantly lower arterial oxygen tension (72.2±15.1 vs 90.2±7.4 mmHg, p