肝硬化出血患者血内皮素动态变化及乌司他丁疗效观察

Dynamic changes of endothelin in cirrhosis patients with hemorrhage and its clinical significance

目的探讨门静脉高压症出血患者血内皮素(ET)变化及意义。方法66例门静脉高压症出血患者随机分为2组:Ⅰ组(n=32)为一般治疗组,Ⅱ组(n=34)为乌司他丁(UTI)治疗组,检测Ⅰ、Ⅱ组出血后1、2、4、7、10、14d血ET变化,并检测1、7、14d的肝功能。另选门静脉高压症未出血患者(n=20),检测血ET,作为对照组。结果出血后7、14d,Ⅰ、Ⅱ组总胆红素(TBIL)、谷丙转氨酶(ALT)、天冬氨酸转氨酶(AST)均呈先升高后下降,但于出血后14dⅡ组较Ⅰ组下降快(P<0.05;P<0.01;P<0.05)。Ⅰ、Ⅱ组出血后1d血ET浓度较对照组显著升高(P<0.01),随后逐步下降。Ⅱ组ET下降较Ⅰ组快,于出血后2d(P<0.05)、4d(P<0.01)、7d(P<0.05),差异有统计学意义。出血后1dⅠ、Ⅱ组ET浓度与总胆红素(TBIL)呈正相关(r=0.734,P<0.01);Ⅰ、Ⅱ组血ET下降指数与TBIL增高指数呈负相关(r=-0.486,P<0.05)。结论门脉高压症大出血后ET升高对肝功能的损害有重要作用,应用UTI治疗可抑制TBIL、ALT、AST、ET等的升高。

Objective To investigate the changes of plasma endothelin (ET) and liver function and evaluate the therapeutic effects of ulinastatin (UTI) in cirrhosis patients with esophageal variceal hemorrhage.Methods A total of 66 cirrhosis patients with esophageal variceal hemorrhage were randomly divided into 2 groups:The patients in group Ⅰ (n=32) received general therapy and those in group Ⅱ (n=34) received the general therapy and UTI after hemorrhage.The plasma ET concentration was measured on the 1st,2nd,4th,7th,10th,and14th day and liver function determined on the 1st,7th and 14th day after the hemorrhage.Other 20 patients without the hemorrhage served as the control group.Results On the 7th and 14th day after hemorrhage,the levels of TBIL,ALT and AST were elevated firstly and then decreased in groups Ⅰ and Ⅱ.The decrease of TBIL,ALT and AST levels was significantly faster in group Ⅱ than in group Ⅰ (P< 0.05, P< 0.01 and P< 0.05 respectively) on the 14th day after hemorrhage.On the 1st day after the hemorrhage the ET concentration was markedly increased in group Ⅰ and Ⅱ as compared with that in the control group (P< 0.01) and then gradually decreased.The ET concentration in group Ⅱ was decreased more rapidly than that in group Ⅰ on the 2nd,4th and 7th day after hemorrhage (P< 0.05, P< 0.01 and P< 0.05,respectively).Meanwhile on the 1st day,the ET concentration was positively correlated to TBIL level in groups Ⅰ andⅡ (r= 0.734, P< 0.01),and the decreased index of ET concentration was negatively correlated to the increased index of TBIL in the 2 groups (r= 0.486, P< 0.05).Conclusion The increased plasma ET in portal hypertensive patients with hemorrhage may contribute to liver injury.UTI can protect liver function by inhibiting ALT,AST,TBIL and ET levels.