经颈静脉肝内门体分流术治疗肝硬化门脉高压症对机体液递物质的影响及疗效

目的探讨经颈静脉肝内门体分流术(TIPS)治疗肝硬化门脉高压症对机体液递物质的影响及其临床疗效评价。方法肝硬化门脉高压症患者40例,分为TIPS组和内科组,每组20例。另选健康成人20例,作为正常对照组。应用放免法及生化分析法测定各组各时段血清一氧化氮(NO)、白细胞介素-6(IL-6)及血浆丙二醛(MDA)的水平,观察临床表现及肝功能的变化。结果TIPS术后所有患者出血停止,一般状况改善明显,TIPS术后1 d血清丙氨酸氨基转移酶(ALT)较术前升高,且差异有显著性(P<0.01),术后7 d有所降低,与术前相比无显著性差异。两治疗组40例患者血清NOI、L-6及血浆MDA水平治疗前后均高于健康正常人(P<0.01)。TIPS组术后NO水平与内科组治疗一周后相比明显升高(P<0.01)。TIPS组术后NO水平较术前明显升高(P<0.01)。结论TIPS治疗肝硬化门静脉高压症近期疗效显著,术后肝功能无明显损害;术后血清NO水平升高,其机制可能与TIPS引起门脉及全身血流动力学变化有关;MDA无明显变化,表明肝脏总的血流灌注减少不明显。

Clinical efficacy and the changes of blood NO, IL-6 and MDA in TIPS

Objective To investigate clinical efficacy and the levels of blood MDA,NO and IL-6 in patients with cirrhosis and portal hypertension after transjugular intrahepatic portosystemic shunt(TIPS).Methods Patients with cirrhosis and portal hypertension companied with upper gastrointestinal tract bleeding were divided into control group(n=20) and TIPS group(n=20),and 20 healthy adults were set as normal control group(n=20).The serum levels of NO,IL-6 and plasma MDA before and after TIPS were detected by radioimmunoassay and biochemistry methods.Clinical findings and hepatic functions were observed.Results All patients had no upper gastrointestinal tract bleeding in the 1st month after TIPS.ALT on postoperative day 1(POD1) was significantly higher than that before TIPS(P<0.01) and insignificantly lower than that before TIPS(P>0.05) on postoperative day 7(POD7).The serums level of NO,IL-6 and plasma MDA of cirrhotic patients in TIPS group and control group before and after treatment were significantly higher than those in the normal control group(P<0.01).Serum level of NO in TIPS group on the POD7 was higher obviously than that in control group in day 7 after internal treatment(P<0.01).The serum level of NO on the POD1,3,7 in TIPS group was significantly higher than that before TIPS(P<0.01).Conclusion The efficacy of TIPS in treating patients with cirrhosis and portal hypertension was obvious,and not much impairment of hepatic functions occurred.Serum level of NO was higher obviously after TIPS,and its mechanism may have relationship with the changes of portal vein and systemic hemodynamic resulting from TIPS.Plasma MDA had no changes,which showed that reduction of total hepatic perfusion had no changes after TIPS.