Simultaneous determination of pulmonary and intestinal permeability in patients with alcoholic liver cirrhosis

The aim of this prospective study was to assess pulmonary and intestinal pe rmeability (PP and IP, respectively) in patients with alcoholic liver cirrh osis (ALC). Thirty-five non-smoking patients with biopsy-proven ALC were in cluded (mean grade B in Child's classification). None had a previous histor y of pulmonary disease and all had a normal chest radiograph and computed t omography scan. Lung function tests and bronchoalveolar lavage (BAL) were a lso performed. The PP was studied by measuring the lung to blood clearance of inhaled Tc-99m-DTPA aerosol. Clearance half-time (T-1/2, in minutes) and residual activity (RA in %) were obtained from exponential fitting of the right pulmonary clearance curve. IP was concurrently evaluated by measuring the urinary recovery of ingested Cr-51-EDTA, according to Bjarnason's tech nique and expressed as a percentage of the total oral dose. Results were co mpared with those obtained in non-smoking healthy control subjects. PP was significantly (P <0.05) increased in patients with ALC (T-1/2 65.9 +/- 32.2 min, RA 87.1%+/-6.7%) versus control subjects (T-1/2 85.2 +/- 20.8 min, RA 92.8%+/-2.6%). IP was not significantly different between patients and con trols (2.39%+/-2.20% vs 1.74%+/-0.81%). A significant correlation (P <0.05) was found between PP and total cell number in BAL and total lymphocyte num ber in BAL. In conclusion, in patients with ALC, PP is increased without an y association with IP, the severity of cirrhosis according to Child's class ification or the results of pulmonary function tests. These findings may re flect primary involvement of the alveolar epithelium. In patients with ALC, PP is correlated with total cell number and total lymphocyte number. Incre ased PP may be due to activated cytotoxic lymphocytes and/or abnormal macro phage activity.