肝硬化失代偿期合并肝肺综合征的临床特征及相关因素分析

摘要/Abstract

摘要： 目的探讨肝硬化失代偿期合并肝肺综合征(HPS)的临床特征及相关因素。方法选取2023年10月至2024年8月在西安交通大学第二附属医院就诊的83例肝硬化失代偿期患者。比较合并与未合并HPS患者的临床资料。应用logistic回归分析探讨发生HPS的影响因素。结果 83例患者中,男性49例(59.0%),51例(61.45%)合并肺内血管扩张(IPVD),33例(39.8%)合并HPS。IPVD阳性患者中54.1%发生HPS。HPS组与非HPS组患者病程、年龄、病因及性别差异无统计学意义(P>0.05)。HPS患者出现胸闷气短17例(51.5%)和发绀8例(24.2%),高于非HPS组的13例(26%)和3例(6%),差异有统计学意义 (P=0.021、0.006)。HPS组和非HPS组既往消化道出血的发生率为51.5%(17/33)和26%(13/50)(P=0.018)。HPS组患者的PaO₂为76(71,87)mmHg,低于非HPS组的87(75,94) mmHg,差异有统计学意义 (P=0.022)。HPS组的Alb显著低于非HPS组 (P=0.018),且HPS组白蛋白-胆红素分级(ALBI) 3级的患者比例 (27.3%) 高于非HPS组的14% (P=0.013)。Logistic回归分析表明,IL-8为HPS的独立危险因素 (OR=1.05, 95%CI=1.017~1.087, P=0.003)。ROC曲线分析显示IL-8对HPS的诊断效能较好,AUC为0.695 (95%CI=0.571~0.818, P=0.004),其特异性为0.913。结论 HPS患者更易出现缺氧症状及发生消化道出血,且肝功能相对较差。IL-8水平可作为HPS诊断的重要指标。

关键词: 肝硬化失代偿期, 肝肺综合征, 临床特征, 消化道出血, 白蛋白, IL-8

Abstract: Objective This study aims to investigate the general clinical characteristics and associated factors of hepatopulmonary syndrome (HPS) in patients with decompensated cirrhosis. Methods A total of 83 patients with decompensated cirrhosis who met the inclusion criteria and were admitted to the Second Affiliated Hospital of Xi′an Jiaotong University from October 2023 to August 2024 were enrolled in this study. The participants were grouped based on the presence or absence of HPS. Comprehensive clinical data and laboratory test results were collected and compared between HPS and Non-HPS groups of patients. Results Among the 83 patients, 59% were male; additionally, 61.45% (51/83) exhibited intrapulmonary vascular dilatations (IPVD), while 39.8% (33/83) had HPS. Notably, HPS was observed in 54.1% of those patients positive for IPVD. No significant differences in disease duration, age, etiology, or gender were found between the HPS group and non-HPS group (P>0.05). Symptoms such as shortness of breath, and cyanosis occurred in 51.5% and 24.2% of HPS patients, respectively, which were significantly higher than those of 26% and 6% reported in the non-HPS group (P=0.021 and 0.006, respectively). The incidence rate of prior gastrointestinal bleeding was recorded at 51.5% within the HPS cohort compared to only 26% among non-HPS individuals (P=0.018). Furthermore, median PaO₂ levels in the HPS group (76 mmHg) were significantly lower than those observed in their non-HPS counterparts (87 mmHg) (P=0.022). Additionally, serum albumin levels within the HPS cohort were markedly reduced compared to those without HPS (P=0.018), with a higher proportion exhibiting albumin-bilirubin score of grade 3 in comparison to that of the non-HPS subjects (27.3% vs. 14%, respectively, P=0.013). Logistic regression analysis identified IL-8 as an independent risk factor for developing HPS (OR=1.05, 95%CI=1.017-1.087, P=0.03). Receiver operating characteristic curve (ROC) analysis indicated that IL-8 demonstrated superior diagnostic efficacy for identifying cases of HPS, with an area under curve (AUC) of 0.695 (95%CI=0.571-0.818, P=0.004) and a specificity rate reaching 0.913. Conclusion Patients diagnosed with hepatopulmonary syndrome are predisposed to hypoxic symptoms alongside increased risks for gastrointestinal bleeding as well as relatively compromised liver function. The level of IL-8 may serve as a crucial biomarker for diagnosing hepatopulmonary syndrome.

Key words: Decompensated cirrhosis stage, Hepatopulmonary syndrome, Clinical manifestations, Gastrointestinal hemorrhage, Albumin, IL-8

苟国娥, 张萌, 杨柳, 孟婷, 李亚萍, 党双锁. 肝硬化失代偿期合并肝肺综合征的临床特征及相关因素分析[J]. 肝脏, 2025, 30(10): 1319-1323.

GOU Guo-e, ZHANG Meng, YANG Liu, MENG Ting, LI Ya-ping, DANG Shuang-suo. An analysis on the clinical characteristics and associated factors of decompensated cirrhosis complicated by hepatopulmonary syndrome[J]. Chinese Hepatolgy, 2025, 30(10): 1319-1323.

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