title: Abnormal Gas Diffusing Capacity and Portosystemic Shunt in Patients With Chronic Liver Disease.
abstract: BACKGROUND
  Pulmonary dysfunctions including the hepatopulmonary syndrome and portosystemic shunt are important complications of hepatic cirrhosis. To investigate the severity and nature of abnormal gas diffusing capacity and its correlation to portosystemic shunt in patients with chronic liver disease.
  
  
  METHODS
  Forty-four patients with chronic liver disease (15 chronic active hepatitis (CAH), 16 Child-Pugh class A, and 13 Child-Pugh class B) without other diseases history were enrolled in the study. Evaluation of liver function tests, arterial blood gases analysis, ultrasonography, pulmonary function test including lung diffusing capacity of carbon monoxide (DLco), forced vital capacity(FVC), forced expiratory volume 1 seconds(FEV1), total lung capacity(TLC), DLco/AV(alveolar volume) and thallium-201 per rectum scintigraphy were performed. We were analyzed correlations between pulmonary function abnormalities and heart/liver (H/L) ratio in patients with chronic liver diseases.
  
  
  RESULTS
  In CAH, percentage of patients with DLco and DLco/VA (< 80%) was 22.2 % but it was significantly increased to 47.2-54.5% in Child-Pugh class A and B patients. The means of DLco and DLco/VA were significantly (P < 0.05) decreased in Child-Pugh class. The mean H/L ratio in Child-Pugh class B increased markedly (P < 0.01) than those with CAH and Child-Pugh class A. The frequency of specific pulmonary function abnormality in patients with Child-Pugh class B was significantly (P < 0.01) greater than those with Child-Pugh class A and CAH. There was a inverse linear correlation between H/L ratio and DLco (r = -0.339, P < 0.05) and DLco/VA (r = -0.480, P < 0.01).
  
  
  CONCLUSIONS
  A total of 62% of patients with advanced liver disease have abnormal pulmonary diffusion capacity with a reduced DLco or DLco/VA and abnormal portosystemic shunt (increased H/L ratio) is common hemodynamic abnormality. Therefore, inverse linear correlation between DLco or DLco/VA and H/L ratio may be an important factor in predicting pulmonary complication and meaningful diagnostic and prognostic parameters in patients with advanced chronic liver disease.
authors: Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 133-791, South Korea.
authors: Moon-Seung
authors: MS
authors: Park
authors: Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 133-791, South Korea.
authors: Min-Ho
authors: MH
authors: Lee
authors: Department of Pharmacology and Clinical Pharmacology Laboratory, Hanyang University, Seoul 133-791, South Korea.
authors: Yoo-Sin
authors: YS
authors: Park
authors: Department of Pharmacology and Clinical Pharmacology Laboratory, Hanyang University, Seoul 133-791, South Korea.
authors: Shin-Hee
authors: SH
authors: Kim
authors: Department of Informative Statistics, College of Natural Science, Pyongteak University, Pyonkteak 450-701, South Korea.
authors: Min-Jung
authors: MJ
authors: Kwak
authors: Department of Pharmacology and Clinical Pharmacology Laboratory, Hanyang University, Seoul 133-791, South Korea.
authors: Ju-Seop
authors: JS
authors: Kang
keywords: CAH; Child-Pugh class; DLco; DLco/VA; Portosystemic shunt (H/L ratio); Pulmonary diffusion capacity