门脉高压症出血病人血内皮素变化及临床意义

Dynamic variation of endothelin in portal hypertensive patients with hemorrhage and its clinical significance

目的:探讨门脉高压症出血病人血内皮素(ET)变化情况及其临床意义。方法:将66例肝硬化门脉高压症出血病人随机分为2组:Ⅰ组(n=32)为一般治疗组,Ⅱ组(n=34)为UTI治疗组,分别检测Ⅰ,Ⅱ组出血后1,2,4,7,10,14d血ET变化情况,并检测1,7,14d的肝功能。另选肝硬化门脉高压症未出血病人(n=20)作为对照组,检测血浆ET。结果:出血后7,14d,Ⅰ,Ⅱ组TBIL,ALT,AST均先升高后下降,但于出血后14d,Ⅱ组较Ⅰ组下降快(分别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2,4,7d有显著差异(分别P<0.05,P<0.01,P<0.05)。出血后1d,Ⅰ,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升高可损害肝功能,应用UTI治疗可抑制TBIL,ALT,AST,ET等升高,起到保护肝功能的作用。

Objective To investigate variations of plasma endothelin （ET） and its clinical signifi-ance in portal hypertensive patients with esophageal variceal hemorrhage. Methods Sixty-six patients with portal hypertension were randomly divided into 2 groups. Group Ⅰ （32 patients） received general therapy and Group Ⅱ （34 patients） received general therapy and UTI after hemorrhage. The plasma ET concentration and liver function were determined at 1, 2, 4, 7,10, and 14 d after the hemorrhage. Another 20 patients without the hemorrhage were elected as the control group. Results At 7 and 14 d after the hemorrhage, the levels of TBIL,ALT and AST were elevated at first 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, P〈0.05, respectively） on 14 d after the hemorrhage. At 1 d after the hemorrhage the ET concentration was markedly increased in Group Ⅰ and Ⅱ as compared with the control group （P〈0.01）. Then it was gradually decreased on 10 d after the hemorrhage. The ET concentration in Group Ⅱ was decreased more rapidly than that in Group Ⅰ on 2,4 and 7 d after the hemorrhage （P〈0.05;P〈0.01：P 〈0.05, respectively）. The ET concentration was positively correlated to TBIL levels in groups Ⅰ and Ⅱ （r=0.734,P〈0.01）. And the decreased index of ET concentration was negatively correlated to the increased index of TBIL （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 the liver function by inhibiting ALT, AST, TBIL and ET level.