State of Acid-Base Balance in Patients with Liver Cirrhosis: Role in the Pathogenesis of Respiratory Lesions; Dependence on the Degree of Liver Damage

Introduction. Liver cirrhosis (LC) as a social and medical problem for a long time does not lose its relevance. The main cause of death of the hepatological patients - comorbid syntropic disorders of other organs and systems, including the respiratory disorders. In the pathogenesis of syntropias there are involved a number of mechanisms, including metabolic disorders, among them - the changes of acid-base balance (ABB), followed by the appearance of the endothelial dysfunction. That's why the aim of our study was to investigate the state of the ABB in the patients with LC, its role in the pathogenesis of the lesions of the respiratory system, depending on the severity of LC according to the criteria of C. G. Child - R. N. Pugh. Materials and methods. 80 patients with LC, who were hospitalized, examined and treated at the Gastroenterological Department of Lviv Regional Clinical Hospital, Lviv Regional Hepatological Center were included into the study. The control group was consisted of 15 healthy individuals identical by the age and gender. For all the patients was performed a comprehensive clinical-laboratory and instrumental examination of all the organs and systems of organs, according to the requirements of the modern medicine and the study of the ABB of blood, including its electrolyte composition through the taking of 1.5 mL of venous blood. According to the results of our study can be seen the tendency of negative dynamics of the indices of the partial pressure of CO2, bicarbonate, standard bicarbonate, excess of the bases in the blood and extracellular fluid, buffer systems, K+ and Na+ levels in patients with LC and their dependence on the severity of the disease according to the criteria of C. G. Child – R. N. Pugh. In all the persons of the diagnosed group there was the intensive reduction of these indices, compared with the reference rates (p < 0.05), indicating the presence of metabolic acidosis, which contributes to the appearance and increase of hypoxemia, leads to the changes in vessels receptors sensitivity to the effects of the vasoactive substances. The reduction of their level in blood of the patients directly proportionally depends on the severity of the disease, and the metabolic disorders can be considered as one of the pathogenic mechanisms in the appearance of syntropic comorbid respiratory disorders, which have a decisive prognostic value and is the leading cause of death of the hepatological patients. Conclusions. The indices of ABB, in patients with liver cirrhosis, were significantly lower (p < 0.05), compared with the reference indices. Deteriorating of the values of ABB directly proportionally depends on the severity of LC, according to the criteria of C. G. Child - R. N. Pugh, and manifested as progressive metabolic acidosis with altered gas composition of blood, which is one of the diagnostic criteria for occurrence of respiratory failure.