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Pulmonale Komplikationen bei Lebererkrankungen

Pulmonary complications in liver diseases

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Zusammenfassung

Wechselwirkungen zwischen dem kardiopulmonalen Kreislauf und der Leber sind bei Patienten mit portaler Hypertension sowie Leberzirrhose häufige Komplikationen. Von wesentlicher Bedeutung sind hierbei das hepatopulmonale Syndrom (HPS), die portopulmonale Hypertension (POPH) sowie der hepatische Hydrothorax. Das HPS tritt bei bis zu 30 % der Patienten mit Leberzirrhose auf und geht mit einer mehr als 2-fach gesteigerten Mortalität einher. Das HPS sollte frühzeitig mittels arterieller Blutgasanalyse und Kontrastmittelechokardiographie diagnostiziert werden, während die POPH, eine Form der pulmonalarteriellen Hypertonie in Zusammenhang mit portaler Hypertension, letztendlich in der Rechtsherzkatheteruntersuchung festgestellt wird. Therapeutische Möglichkeiten sind eine Langzeitsauerstofftherapie und die orthotope Lebertransplantation für das schwere HPS. Bei der POPH ist v. a. eine medikamentöse Therapie mit Vasodilatoren, wie Prostazyklinen, Endothelinrezeptorantagonisten und Phosphodiesterase-5-Hemmern indiziert. In der folgenden Übersicht werden die erwähnten Krankheitsbilder dargestellt, wobei ein Schwerpunkt auf das HPS gelegt wird.

Abstract

Pulmonary–hepatic vascular disorders are frequent complications in patients with portal hypertension and cirrhosis. Hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), and hepatic hydrothorax are relevant disease entities in these patients. HPS occurs in up to 30 % of patients with cirrhosis and is associated with a more than 2-fold increased mortality. The diagnosis of HPS should be established early by arterial blood gas analysis and contrast-enhanced echocardiography, whereas POPH is diagnosed by the presence of pulmonary arterial hypertension evaluated via right heart catheterization and the presence of portal hypertension. Therapeutic options include initiation of long-term oxygen therapy and liver transplantation in patients with severe HPS. Patients with POPH should receive targeted medical therapies with endothelin receptor antagonists, phosphodiesterase-5 inhibitors and/or prostanoids. In contrast, β-blockers should be avoided. This review summarizes current knowledge regarding pulmonary–hepatic vascular disorders, with a focus on HPS.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Horvatits, A. Drolz, K. Rutter und S. Kluge geben an, dass kein Interessenkonflikt besteht. V. Fuhrmann erhielt Forschungsunterstützung von den Firmen Actelion, Vivisol und Air Liquide. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    T. Horvatits, A. Drolz, K. Rutter, S. Kluge &  V. Fuhrmann

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  1. T. Horvatits
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  2. A. Drolz
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  3. K. Rutter
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  4. S. Kluge
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Correspondence to V. Fuhrmann.

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Horvatits, T., Drolz, A., Rutter, K. et al. Pulmonale Komplikationen bei Lebererkrankungen. Med Klin Intensivmed Notfmed 109, 235–239 (2014). https://doi.org/10.1007/s00063-013-0319-y

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