Kronik karaciğer hastalığında hepatopulmoner sendromun 99mTc-MAA sintigrafisi ile erken teşhisi
Küçük Resim Yok
Tarih
1997
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info:eu-repo/semantics/openAccess
Özet
Kronik karaciğer hastalığında intrapulmoner arteryove-nb'z fistüllere bağlı olarak hipoksi gelişimi sıktır. Bu çalışmada, siroz olgularında gelişen hepatopulmoner sendrom (HPS) var¬lığının gösterilmesi amaçlandı. Onbeş siroz olgusu (4 K, 11 E), 18 kontrol olgusu (8 K, 10 E) çalışmaya alındı. Yaş ortalaması hasta grubunda 55±13 yıl, kontrol grubunda 50±15yılidi. Ol¬gulara 99mTc-MAA sintigrafisi, solunum fonksiyon testleri, ak¬ciğer difüzyon kapasitesi ölçümü, kan gazları analizi, endosko-pi, ultrasonografi ve biyokimyasal testler yapıldı. Özofagus va¬risi 13, spider 8, çomak parmak 3, ortodeoksi 9, platipne 11, hi¬poksi 4 olguda saptandı. Üç olgu CHILD A, 6 sı B, 6 sı C gru¬bunda idi. Her iki grupta yatarken yapılan PaO2 ölçümleri arasında anlamlı fark yoktu. Ayakta yapılan ölçümlerde has¬ta grubunun PaO2 değerinde belirgin azalma saptandı (p< 0.03). Yatarken ve ayakta PaCO2 değerleri ise, hasta grubun¬da kontrol grubuna göre anlamlı düzeyde artmış bulundu (p< 0.03 ve p< 0.02). 99mTc-MAA' nm PV enjeksiyonundan 5 ve 30 dk sonra 300 saniye süreli statik görüntüler alınarak şant in¬deksi (Şl) hesaplandı. Sistemik aktivitenin total aktiviteye oranlanması ile elde edilen Şİ değerleri, 5. dk için hasta gru¬bunda: % 12.1±2.7, kontrol grubunda: % 5.0±l.l; 30 dk için sı¬rası ile, % 30.4 ±6.8 ve % 14.3±3.2 bulundu (p< 0.05). CHILD grupları arasında farklılık yoktu. Her iki grup için beyin I ak¬ciğer, böbrek I akciğer oranlanarak erken ve geç dönemde he¬saplanan Şl değerleri arasındaki fark anlamlı değildi. DLCO ve DLCO/VA değeri 9 olguda azalmıştı. Hasta grubunun DLCO (%71±18) ve DLCO I VA (73±19) değerleri kontrol gru¬buna göre (% 98 ± 9 ve 87±6) istatistiksel olarak anlamlı azal¬ma gösterdi (sırası ile, p < 0.008 ve 0.03). Çalışmamız sonucun¬da, siroz olgularında ortodeoksi varlığı, DLCO ve DLCO I VA değerlerinde azalma ile 99mTc-MAA enjeksiyonunu takiben erken donemde şant indeksi artışının HPS tanısında faydalı parametreler olduğu görüşünde birleşildi.
Patients with end-stage liver disease frequently ex¬hibit pulmonary circulatory dysfunction manifested by intra-pulmonary vascular shunting , and arterial hypoxemia. The aim of this study was to detect hepatopulmonary shunt syndro¬me (HPSS) developing in cirrhosis. Fifteen patients with cirr¬hosis (4 F, 11 M), 18 control cases (8 F, 10 M) were included study group. The mean age was 56±13 yr. and 50+15 yr., res¬pectively. 99mTc&#8212;MAA scintigraphy, pulmonary function tes¬ting, pulmonary diffusion capacity, endoscopy, analyses of arte¬rial blood gases ,ultrasonography and the routine biochemical studies were performed . We detected esophageal varices in 13, spider in 8, clubbing in 3, orthodeoxia in 9, platypnea in 11, hypoxemia in 4 patients. Three patients were in CHILD A, 6 patients in B, and 6 patients in C. Although there was no a sig¬nificant difference between two groups for PaO2 values me¬asured in supine position, PaO2 values in erect position were significantly decreased in patients with chronic liver disease (p< 0.03). Patients' PaC02 values in both position were hig¬her than that of control cases (Supine: p< 0.03 and Erect: p< 0.02) . We calculated right to left shunt index (SI) in the image obtained both 5 and 30 min after PV injection of 99mTc-MAA. In early images, SI calculated by using systemic activity I to¬tal activity ratio was 12.1±2.7 % in patient group, and 5.0+1.1 % in control group. In late images, these values were 30.4±6.8 % and 14.3±3.2 % , respectively, (p< 0.05). A significant diffe¬rence was not detected among CHILD groups. We determined that DLCO and DLCO I VA decreased in 9 patients. In patient group, DLCO (71+18%) and DLCO I VA (73+19) were promi¬nently lower than that ones in control group (98+9% and 87±6, p<0.008 and p<0.03). Consequently, we conclude that orthodeoxia, reduced DLCO and DLCO I VA and an increased shunt index calcuulated by using systemic activity I total acti¬vity ratio in early 99mTc-MAA images are useful parameters in the diagnosis of HPSS in cirrhotic patients.
Patients with end-stage liver disease frequently ex¬hibit pulmonary circulatory dysfunction manifested by intra-pulmonary vascular shunting , and arterial hypoxemia. The aim of this study was to detect hepatopulmonary shunt syndro¬me (HPSS) developing in cirrhosis. Fifteen patients with cirr¬hosis (4 F, 11 M), 18 control cases (8 F, 10 M) were included study group. The mean age was 56±13 yr. and 50+15 yr., res¬pectively. 99mTc&#8212;MAA scintigraphy, pulmonary function tes¬ting, pulmonary diffusion capacity, endoscopy, analyses of arte¬rial blood gases ,ultrasonography and the routine biochemical studies were performed . We detected esophageal varices in 13, spider in 8, clubbing in 3, orthodeoxia in 9, platypnea in 11, hypoxemia in 4 patients. Three patients were in CHILD A, 6 patients in B, and 6 patients in C. Although there was no a sig¬nificant difference between two groups for PaO2 values me¬asured in supine position, PaO2 values in erect position were significantly decreased in patients with chronic liver disease (p< 0.03). Patients' PaC02 values in both position were hig¬her than that of control cases (Supine: p< 0.03 and Erect: p< 0.02) . We calculated right to left shunt index (SI) in the image obtained both 5 and 30 min after PV injection of 99mTc-MAA. In early images, SI calculated by using systemic activity I to¬tal activity ratio was 12.1±2.7 % in patient group, and 5.0+1.1 % in control group. In late images, these values were 30.4±6.8 % and 14.3±3.2 % , respectively, (p< 0.05). A significant diffe¬rence was not detected among CHILD groups. We determined that DLCO and DLCO I VA decreased in 9 patients. In patient group, DLCO (71+18%) and DLCO I VA (73+19) were promi¬nently lower than that ones in control group (98+9% and 87±6, p<0.008 and p<0.03). Consequently, we conclude that orthodeoxia, reduced DLCO and DLCO I VA and an increased shunt index calcuulated by using systemic activity I total acti¬vity ratio in early 99mTc-MAA images are useful parameters in the diagnosis of HPSS in cirrhotic patients.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Turkish Journal of Gastroenterology
WoS Q Değeri
Scopus Q Değeri
Cilt
8
Sayı
4
