Transthoracic Contrast Echocardiography to Detect Pulmonary Vascular Dilatation in Liver Cirrhosis Caused by Hepatitis Virus in Taiwan

使用經胸壁對比超音波評估台灣地區病毒性肝硬化肺內血管擴張之經驗

吳健嘉(Victor Chien-Chia Wu) ； Valerie Zarza ； 邱正堂(Cheng-Tang Chiu) ； 李威震(Wei-Chen Lee) ； 張伯丞(Po-Cheng Chang) ； 洪國峻(Kuo-Chun Hung) ； Jay Borinaga ； 陳天心(Tien-Hsing Chen) ； 溫明賢(Ming-Shien Wen) ； 吳德朗(De-Lon Wu) ； 林芬瓊(Fen-Chiung Lin)

《臺灣消化醫學雜誌》 27卷4期 (2010/12) Pp. 436-443

https://doi.org/10.6557/GJT.201012_27(4).0006

摘要

Background and Purpose: The natural history of hepatopulmonary syndrome (HPS) has high mortality rate in 5 years in patients with liver cirrhosis. Transthoracic contrast echocardiography (TCE) has been a valuable noninvasive tool to detect pulmonary vascular dilatation. Previous studies have disclosed that there is no relationship between the presence or severity of the HPS and the severity of liver disease. However, the status of pulmonary vascular dilatation in liver cirrhosis is lack in Taiwan. We conduct a prospective cohort study to explore the pulmonary vascular dilatation using TCE in hepatitis virus related liver cirrhosis and further correlate with the severity of Child-Turcotte-Pugh (CTP) classification and Model for End-stage Liver Disease (MELD) scores.
Material and Methods: During two and one half years period, a consecutive series of 136 patients with pathology and/or image study confirmed liver cirrhosis were enrolled into this study. All patients were seropositive for hepatitis B surface antigen and/or antibody against hepatitis C virus. All patients received transthoracic echocardiography TCE examination after entered the study.
Results: Ninety-three (68.4%) of the 136 patients had a positive TCE result. The proportion of patients with positive TCE was significantly higher in CTP classification C (CTP-C) (69/96, 71.9%) and CTP-B (20/29, 69.0%) than in CTP-A (4/11, 45.5%) (P＜0.001). The higher the CTP scores, the higher the TCE positive rates were detected. (P＜0.001). Using Pearson's correlation, the positive TCE is negatively correlated with MELD (P=0.036), International Normalized Ratio of Prothrombin Time (INR) (P=0.037), and bilirubin (P=0.008).
Conclusion: TCE can be a useful non-invasive tool in the detection of pulmonary vascular dilatation in hepatitis virus related liver cirrhosis. The result of positive TCE is correlated with CTP classification. MELD scores, INR and total bilirubin level are negatively association with liver cirrhosis in Taiwan. The pathogenesis and clinical significance of the latter findings await further study.

關鍵字

經胸壁對比超音波檢查 ； 肝硬化 ； 肝肺症候群 ； 肺內血管擴張

並列摘要

Background and Purpose: The natural history of hepatopulmonary syndrome (HPS) has high mortality rate in 5 years in patients with liver cirrhosis. Transthoracic contrast echocardiography (TCE) has been a valuable noninvasive tool to detect pulmonary vascular dilatation. Previous studies have disclosed that there is no relationship between the presence or severity of the HPS and the severity of liver disease. However, the status of pulmonary vascular dilatation in liver cirrhosis is lack in Taiwan. We conduct a prospective cohort study to explore the pulmonary vascular dilatation using TCE in hepatitis virus related liver cirrhosis and further correlate with the severity of Child-Turcotte-Pugh (CTP) classification and Model for End-stage Liver Disease (MELD) scores.
Material and Methods: During two and one half years period, a consecutive series of 136 patients with pathology and/or image study confirmed liver cirrhosis were enrolled into this study. All patients were seropositive for hepatitis B surface antigen and/or antibody against hepatitis C virus. All patients received transthoracic echocardiography TCE examination after entered the study.
Results: Ninety-three (68.4%) of the 136 patients had a positive TCE result. The proportion of patients with positive TCE was significantly higher in CTP classification C (CTP-C) (69/96, 71.9%) and CTP-B (20/29, 69.0%) than in CTP-A (4/11, 45.5%) (P＜0.001). The higher the CTP scores, the higher the TCE positive rates were detected. (P＜0.001). Using Pearson's correlation, the positive TCE is negatively correlated with MELD (P=0.036), International Normalized Ratio of Prothrombin Time (INR) (P=0.037), and bilirubin (P=0.008).
Conclusion: TCE can be a useful non-invasive tool in the detection of pulmonary vascular dilatation in hepatitis virus related liver cirrhosis. The result of positive TCE is correlated with CTP classification. MELD scores, INR and total bilirubin level are negatively association with liver cirrhosis in Taiwan. The pathogenesis and clinical significance of the latter findings await further study.

並列關鍵字

transthoracic contrast echocardiography ； liver cirrhosis ； hepatopulmonary syndrome ； pulmonary vascular dilatation