BACKGROUND: Hepatopulmonary syndrome (HPS) refers to the association of hypoxemia, intrapulmonary shunting and chronic liver disease. But there is no clear data about the prevalence of HPS in postnecrotic liver cirrhosis by hepatitis B virus(HBV), the most common cause of liver disease in Korea. The aim of this study was to investigate the prevalence of HPS in poorly compensated postnecrotic liver cirrhosis by HBV, and the correlation of the hepatopulmonary syndrome with clinical aspects of postnecrotic liver cirrhosis by HBV. METHODS: Thirty-five patients underwent pulmonary function test, arterial blood gas analysis and contrast-enhanced echocadiography. All patients were diagnosed as HBV-induced Child class C liver cirrhosis and had no evidence of intrinsic cardiopulmonary disease. RESULTS: Intrapulmonary shunt was detected in 6/35 (17.1%) by contrast- enhanced echocariography. Two of six patients with intrahepatic shunts had significant hypoxemia (PaO2 < 70 mmHg) and four showed increased alveolar- arterial oxygen gradient over 20 mmHg. Only cyanosis could reliably distinguish between shunt positive and negative patients. CONCLUSIONS: The prevalence of intrapulmonary shunt in poorly compensated postnecrotic liver cirrhosis by HBV was 17.1% and the frequency of hepatopulmonary syndrome was relatively low (5.7%). 'Subclinical' hepatopulmonary syndrome (echocardiographically postive intrapulmonary shunt but without profound hypoxemia) exists in 11.4% of cases with poorly compensated postnecrotic liver cirrhosis by HBV. Cyanosis is the only reliable clinical indicator of HPS of HBV- induced poorly compensated liver cirrhosis. Further studies are required to determine if the prevalence and clinical manifestations of HPS varies with etiology or with geographical and racial differences.
Adult ; Aged ; Analysis of Variance ; Comorbidity ; Female ; Hepatitis B/diagnosis/*epidemiology ; Hepatopulmonary Syndrome/diagnosis/*epidemiology ; Human ; Korea/epidemiology ; Liver Cirrhosis/classification/*epidemiology ; Male ; Middle Age ; Necrosis ; Prevalence ; Probability ; Respiratory Function Tests ; Risk Assessment

PURPOSE: There have been studies concerning prognostic factors in patients with hepatocellular carcinoma (HCC) undergoing transcatheter arterial chemoembolization (TACE) but they reported different prognostic factors from each other. The aim of this study is to determine which prognostic factors contribute to long-term survival after TACE of hepatocellular carcinoma. MATERIAL AND METHOD: Two hundred and forty-one patients with HCC who had been treated by TACE were analyzed retrospectively. TACE was accomplished by hepatic arterial infusion of a suspension of lipodol and anticancer drugs (Mitomycin-C and Adriamycin), either alone or followed by gelfoam embolization. RESULTS: Male to female ratio was 4.7:1. Mean survival was 13.98 months. Maximum survival was 101 months. The overall cumulative survival rates at the end of the first and second years were, respectively, 41.54% and 20.06%. According to univariate analysis (log-rank scale test), variables significantly associated with survival were: sex, liver cirrhosis, Child-Pugh classification, gross type of the tumor, location of the tumor, size of the tumor, TNM stage, metastasis, portal vein thrombosis, arterioportal shunt, ascites, AFP, protein, albumin, alkaline phosphatase, AST, AST/ALT ratio, total bilirubin, and sodium. Multivariate analysis (Cox proportional hazard model) for the significant variables in a univarariate analysis revealed that the gross type of the tumor, portal vein thrombosis, and Child-Pugh classification were statistically significant independent prognostic factors. CONCLUSION: The prognosis of patients with HCC treated with TACE was affected favorably by the nodular type tumor, the patent main and the first-order portal vein, and the good liver function (Child-Pugh class A).
Alkaline Phosphatase ; Ascites ; Bilirubin ; Carcinoma, Hepatocellular* ; Classification ; Epidemiology ; Female ; Gelatin Sponge, Absorbable ; Humans ; Liver ; Liver Cirrhosis ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Portal Vein ; Prognosis ; Retrospective Studies ; Sodium ; Survival Rate* ; Venous Thrombosis