肝硬化门脉系统血流动力学与血浆胰高血糖素的关系

Relationship between Changes of Portal System Hemodynamics and Levels of Plasma Glucagon in Patients with Liver Cirrhosis

目的探讨肝硬化患者血浆胰高血糖素(GLU)水平的改变及其与肝功能损害和门脉血流动力学的关系。方法用放射免疫分析法测定42例肝硬化患者和20例对照组的空腹血浆GLU水平,用彩色多普勒超声测定门静脉及脾静脉的直径、流速和血流量。结果肝硬化患者门脉系统存在血流动力学异常,血浆GLU水平显著高于对照组(P<0.01),按肝功能Child-Pugh分级将肝硬化患者分为A、B、C 3组,各组血浆GLU水平依次升高。合并腹水的肝硬化患者血浆GLU水平显著高于未合并腹水者(P<0.05)。血浆GLU水平与门静脉和脾静脉的直径以及脾静脉的流量呈显著正相关(r分别为0.502、0.504、0.491,P均<0.01)。结论肝硬化患者血浆GLU水平升高反映了肝功能损害的严重程度,同时在门静脉高压的形成和发展过程中起着重要的作用。

Objective To investigate the changes of plasma levels of glucagon in cirrhotic patients and its effect on the pathogenesis of portal hemodynamics. Methods Plasma levels of glucagon were measured by radioimmunoassay （RIA） in 42 patients with liver cirrhosis and 20 healthy controls. The max diameters, mean flow velocity, flow rate of the portal vein trunks （PV） and splenic veins（SV） were detected by color doppler ultrasound. Results Plasma levels of glucagon in cirrhotic patients were significantly higher than those in controls and were increased with the severity of hepatic function impairment as assessed by Child-Pugh grade（P〈0.01）. The patients with ascites showed significant higher plasma glucagon levels than those without ascites. Plasma levels of glucagon were positively correlated with portal veiniameters,splenic vein diameters and splenic vein flows（r=0. 502,0. 504 and 0. 491,P〈0.01）. Conclusion The increase of plasma glucagon levels reflects, in part, the severity of impairment of hepaticfunction. In addition, it may contribute to the pathogenesis of portal hypertension.