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>Revistas >Gaceta Médica de México >Año 2012, No. 2


Uribe M, Morales-Blanhir J, Rosas-Romero R, Campos CR, Poo JL
Epidemiología, fisiopatología y diagnóstico de la hipertensión arterial pulmonar (HAP) en el cirrótico
Gac Med Mex 2012; 148 (2)

Idioma: Español
Referencias bibliográficas: 74
Paginas: 153-161
Archivo PDF: 102.70 Kb.


Texto completo




RESUMEN

La cirrosis hepática es la fase avanzada de un gran número de padecimientos crónicos del hígado, en el que se desarrollan cambios estructurales de la arquitectura hepática con presencia de fibrosis y nódulos de regeneración. En países en vías de desarrollo, la etiología más frecuente es la hepatitis crónica por consumo de alcohol, seguida por las infecciones virales crónicas, como la del virus de la hepatitis C (VHC).
La insuficiencia hepática secundaria a la cirrosis induce una serie de modificaciones hemodinámicas en todos los niveles vasculares; se caracteriza por incremento del volumen vascular, disminución de las resistencias vasculares sistémicas e incremento del gasto cardíaco. La hipertensión portal es la complicación hemodinámica con mayor importancia en la cirrosis, ya que promueve una serie de cambios en la circulación portal, esplénica, pulmonar y sistémica que se relacionan con procesos fisiopatológicos y enfermedades cardiopulmonares.
La HAP es una enfermedad que, en ausencia de enfermedad cardiovascular izquierda, se encuentra relacionada con cambios estructurales de las arterias pulmonares. Es el resultado de una serie de señales celulares que se traducen en hipertrofia arterial, con incremento del tono vascular y de la presión arterial pulmonar.
La hipertensión portopulmonar (HPP) es la coexistencia de hipertensión portal e HAP. Para cumplir con los criterios diagnósticos no debe existir enfermedad cardiovascular izquierda que contribuya a la hipertensión pulmonar. En esta entidad existen componentes hemodinámicos importantes: hipertensión portal, cambios del flujo vascular, estimulación celular e hipertrofia arterial pulmonar. En esta revisión, la epidemiología, la fisiopatología y el diagnóstico son descritos para el diagnóstico temprano y el tratamiento.


Palabras clave: Cirrosis hepática, Hipertensión portal, HPP, HAP, Gradiente portosistémico.


REFERENCIAS

  1. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-51.

  2. Burroughs AK, Thalheimer U. Hepatic Venous Pressure Gradient in 2010: Optimal. Measurement Is Key. Hepatology. 2010;51:1894-96.

  3. Badesh DB, Champion HC, Sánchez MA, et al. Diagnosis and Assessment of Pulmonary Arterial Hypertension. J Am Coll Cardiol. 2009;54: S55-66.

  4. Task Force for Diagnosis and Treatment of Pulmonary Hypertension of European Society of Cardiology (ESC); European Respiratory Society (ERS); International Society of Heart and Lung Transplantation (ISHLT), et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2009;34(6):1219-63.

  5. Saleemi S. Portopulmonary hypertension. Ann Thorac Med. 2010;5:5-9.

  6. Krowka MJ. Portopulmonary hypertension: diagnostic advances and caveats. Liver Transpl. 2003;32:2177-8.

  7. Roberts KE, Fallon MB, Krowka MJ, et al. Genetic risk factors for portopulmonary hypertension in patients with advanced liver disease. Am J Respir Crit Care Med. 2009:179; 835-42.

  8. Kuo PC, Plotkin JS, Gaine S, et al. Portopulmonaryhipertension and the liver transplant candidate. Transplantation. 1999;67:1087-93.

  9. Naveau S, Giraud V, Ganne N, et al. Patients with alcoholic liver disease hospitalized in gastroenterology. A national multicenter study. Gastroenterol Clin Biol. 2001;25(2):131-6.

  10. Monterrubio D, Marin EL, Larrauri JR, Gusman-Carrera R, Romero M. Epidemiologia de la cirrosis hepatica en la ciudad de Puebla. Rev Gastro Mex 1987 (52)3;175-8.

  11. Poo JL, Delgadillo-Torre A, López-Fuerte F, et al. Consenso mexicano sobre diagnóstico y tratamiento de la cirrosis hepática. 02/03/09 [Internet] Disponible en: http://hepatologia.org.mx/LineamientosdelConsensodeCirrosis.pdf.

  12. Rodríguez-Hernández H, Jacobo-Karam JS, Castañón-Santillán MC, Arámbula-Chávez M, Martínez-Aguilar G. Supervivencia de pacientes con cirrosis hepática en el Hospital General Regional del IMSS, Durango. Gac Med Mex. 2002;138:325-31.

  13. Méndez-Sánchez N, Villa AR, Chávez-Tapia NC, et al. Trends in liver disease prevalence in Mexico from 2005 to 2050 through mortality data. Ann Hepatol. 2005;4:52-5.

  14. McLaughlin V. Classification and epidemiology of pulmonary hypertension. Cardiol Clin. 2004;22:327-41.

  15. Lebrec D, Capron JP, Benhamou JP. Primary pulmonary hypertension and portal hypertension. Am Rev Respir Dis. 1979;120:849-56.

  16. Portmann R, Stewart S, Higenbottam TW, Clayton PT, Lloyd JK, Williams R. Nodular transformation of liver associated with portal and pulmonary artery hypertension. Gastroenterology. 1993;104: 616-21.

  17. Budhiraja R, Hassoun PM. Portopulmonary Hypertension: A Tale of Two Circulation. Chest. 2003;123:562-76.

  18. McDonnell PJ, Toye PA, Hutchins GM. Primary pulmonary hypertension and cirrhosis: are they related. Am Rev Respir Dis 1983;127(4):437-41.

  19. Snouber JM, Malik GM. Hepatopulmonary Syndrome and portopulmonary hypertension. JK-Practitioner. 2004;11:60-1.

  20. Ferrell L. Liver pathology: cirrhosis, hepatitis, and primary liver tumors. update and diagnostic problems. Mod Pathol. 2000;13:679-704.

  21. Rodríguez-Vilarrupla A, Fernández M, Bosch J, García Pagán JC. Current concepts on the pathophysiology of portal hypertension. Ann Hepatol. 2007;6:28-36.

  22. Boyer TD. Portal hypertensive hemorrhage.Pathogenesis and risk factors. Semin Gastrointest Dis. 1995;6:125-33.

  23. Kapoor D, Sarin SK. Pathophysiology of portal hypertension. J Gastroenterol Hepatol. 2002;17:S482-7.

  24. Comar KM, Sanyal AJ. Portal hypertensive bleeding. Gastroenterol Clin North Am. 2003;32:1079-105.

  25. Bosch J, García-Pagán JC. Complications of cirrhosis. I. Portal hypertension. J Hepatol. 2000;32:141-56.

  26. Gupta TK, Chen L, Groszmann RJ. Pathophysiology of portal hypertension. Clin Liver Dis. 1997;1:2-15.

  27. Ozaki M, Kawashima S, Yamashita T, et al. Reduced hypoxic pulmonary vascular remodeling by nitric oxide from the endothelium. Hypertension. 2001;37:322-7.

  28. Morales-Ruiz M, Cejudo-Martin P, Fernández-Varo G. Transduction of the liver with activated Akt normalizes portal pressure in cirrhotic rats. Gastroenterology. 2003;125:522-31.

  29. La Villa G, Barletta G, Pantaleo P, et al. Hemodynamic, renal, and endocrine effects of acute inhibition of nitric oxide synthase in compensated cirrhosis. Hepatology. 2001;34:19-27.

  30. Fevery J, Roskams T, Van de Castele M, et al. NO synthase in the liver, prospects of in vivo gene transfer. Digestion. 1998;59 Suppl 2:58-9.

  31. Shah V, Totuner M, Haddad F, et al. Impaired endothelial nitric oxide synthase activity associated with enhanced caveolin binding in experimental cirrhosis in the rat. Gastroenterology. 1999;117:1222-8.

  32. Reynaert H, Thompson MG, Thomas T. Hepatic stellate cells: role in microcirculation and pathophysiology of portal hypertension. Gut. 2002;50:571-80.

  33. Montaño LA, Meza JJ. Patogénesis de la hipertensión portal. Rev Invest Clin. 2005;57:596-607.

  34. Turder RM, Cool CD, Geraci MW, et al. Prostacyclin synthase expression is decreased in lungs from patients with pulmonary hypertension. Am J Respir Crit Care Med. 1999;159:1925-32.

  35. Deng Z, Morse JH, Slager SL. Familial primary pulmonary hypertension (gene PPH1) is caused by mutations in the bone morphogenetic protein receptor-II gene. Am J Hum Genet. 2000;67:737-44.

  36. Harrison RE, Flanagan JA, Sankela M, et al. Molecular and functional analysis identifies ALK-1 as the predominant cause of pulmonary hypertension related to hereditary hemorrhagic telangiectasia. J Med Genet. 2003;40:865-71.

  37. Boutet K, Montani D, Jaïs X, et al. Therapeutic Advances in Pulmonary Arterial Hypertension. Ther Adv Resp Dis. 2008;2:249-65.

  38. Lee SD, Shroyer KR, Markham NE, Cool CD, Voelkel NF, Tuder RM. Monoclonal endothelial cell proliferation is present in primary but not secondary pulmonary hypertension. J Clin Invest. 1998;101:927-34.

  39. Steiner MK, Syrkina OL, Kolliputi N, Mark EJ, Hales CA, Waxman AB. Interleukin-6 overexpression induces pulmonary hypertension. Circ Res. 2009;104:236-44.

  40. Keyes JW, Wilson GA, Quinonest JD. An evaluation of lung uptake of colloid during liver imaging. J Nucl Med. 1973;14:687-91.

  41. Alam I, Bass NM, Bacchett P. Hepatic tissue levels of endothelin-1 correlate with severity of chronic liver disease and ascites. Am J Gastroenterol. 2000;95:199-203.

  42. Kereveu A, Callebert J, Humbert M. High plasma serotonin levels in primary pulmonary hypertension. Arterioscler Thromb Vasc Biol. 2000;20:2233-9.

  43. Beaudry P, Hadangue A, Callbert J. Blood and plasma 5-hydroxytryptamine levels in patients with cirrhosis. Hepatology. 1994;20:800-3.

  44. Ginés P, Quintero E, Arroyo V, Terés J, Bruguera M, Rimola A. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7:122-8.

  45. Saunders JB, Davis M, Williams R. Do women develop alcoholic liver disease more readily than men? Br Med J. 1981;282:1140-3.

  46. 46 Hultcrantz R, Glaumann H, Lindberg G. Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotranferases. Scand J Gastroenterol. 1989;21:109-15.

  47. Smith LG, Camilo ME, Dick R. Percutaneous transhepaticportography in the assessment of portal hypertension. Gastroenterology. 1980;78: 197-202.

  48. Treiber G, Csepregi A, Malfertheiner P. The pathophysiology of portal hypertension. Dig Dis. 2005;23:6-10.

  49. Barst RJ, McGoon M, Torbicki A, et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardio. 2004;43:40s-7.

  50. Schannwell CM, Steiner S, Strauer BE. Diagnostics in pulmonary hypertension. J Physiol Pharmacol. 2007;58:591-602.

  51. Marius MH, Michael JK, Christian PS. Portopulmonary hypertension and hepatopulmonary syndrome. Lancet. 2004;363:1461-8.

  52. Radulescu D, Duncea C, Donca V. Hepatic cirrosis associated with arterial pulmonary hipertensión. Rom J Gastroenterol. 2004;13:341-3.

  53. Swanson KL, Krowka MJ. Screen for portopulmonary hypertension, especially in liver transplant candidates. Cleve Clin J Med. 2008;75:121-36.

  54. Chemla D, Castelain V, Hervé P, Lecarpentier Y, Brimioulle S. Haemodynamic evaluation of pulmonary hypertension. Eur Respir J. 2002;20: 1314-31.

  55. Krowka MJ, Plevak DJ, Findlay JY, Rosen CB, Wiesner RH, Krom RA. Pulmonary hemodynamics and perioperative cardiopulmonary-related mortality in patients with portopulmonary hypertension undergoing liver transplantation. Liver Transpl. 2000;6:443-50.

  56. Hadengue A, Benhayoun MK, Lebrec D, Benhamou JP. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology. 1991;100:520-8.

  57. Auletta M, Oliviero U, Iasiuolo L, Scherillo G, Antoniello S. Pulmonary hypertension associated with liver cirrosis: an echocardiographic study. Angiology. 2000;51:1013-20.

  58. Herve P, Lebrec D, Brenot F, Simonneau G, Humbert M, Sitbon O. Pulmonary vascular disorders in portal hypertension. Eur Respir J. 1998;11:1153-66.

  59. Krowka MJ. Pulmonary hypertension: diagnostics and therapeutics. Mayo Clin Proc. 2000;75:625-30.

  60. Gaine S. Pulmonary hypertension. JAMA. 2000;284:3160-8.

  61. Kawut SM, Krowka MJ, Trotter JF, et al. Clinical risk factors for portopulmonary hypertension. Hepatology. 2008;48:196-203.

  62. Kuo PC, Plotkin JS, Johnson LB, Howell CD, Laurin JM, Bartlett ST. Distinctive clinical features of portopulmonary hypertension. Chest. 1997;112:980-6.

  63. Chan T, Palevsky HI, Miller WT. Pulmonary hypertension complicating portal hypertension: findings on chest radiographs. Am J Roentgenol. 1988;151:909-14.

  64. Nagaya N, Nishikimi T, Okano Y, et al. Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol. 1998;31:201-11.

  65. Kim WR, Krowka MJ, Plevak DJ, et al. Accuracy of Doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates. Liver Transpl. 2000;6:453-8.

  66. Torregrosa M, Genesca J, González A, et al. Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates. Transplantation. 2001;71:572-4.

  67. Swanson KL, Mc Goon MD, Krowka MJ. Survival in portopulmonary hypertension. Am J Respir Crit Care Med. 2003;167:A683.

  68. Rodríguez-Roisin R, Krowka MJ, Herve P, Fallon MB. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J. 2004;24:861-80.

  69. Hoeper MM, Halank M, Marx C, Hoeffken G, Seyfarth HJ, Schauer J. Bosentan therapy for portopulmonary hypertension. Eur Respir J. 2005;25:502-8.

  70. Sitbon O, Badesch DB, Channick RN, Frost A, Robbins IM, Simonneau G. Effects of the dual endothelin receptor antagonist bosentan in patients with pulmonary arterial hypertension: a 1-year follow-up study. Chest. 2003;124:247-54.

  71. Callejas Rubio JL, Salmerón Escobar J, González-Calvin J, Ortego Centeno N. Successful treatment of severe portopulmonary hypertension in a patient with Child C cirrhosis by sildenafil. Liver Transpl. 2006; 12:690-1.

  72. Chua R, Keogh A, Miyashita M. Novel use of sildenafil in the treatment of portopulmonary hypertension. J Heart Lung Transplant. 2005;24: 498-500.

  73. Makisalo H, Koivusalo A, Vakkuri A, Hockerstedt K. Sildenafil for portopulmonary hypertension in a patient undergoing liver transplantation. Liver Transpl. 2004;10:945-50.

  74. Van der Linden P, Le Moine O, Ghysels M, Ortinez M, Deviere J. Pulmonary hypertension after transjugular intrahepatic portosystemic shunt: effects on right ventricular function. Hepatology. 1996;23: 982-7.



>Revistas >Gaceta Médica de México >Año2012, No. 2
 

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