慢性型门脉高压时胃微循环调节的形态特征及影响因素

Morphological Characters and Influencing Factors of Adjustment Response in Gastric Microcirculation to Chronic Portal Hypertension in Rats

探讨慢性型门脉高压条件下胃微循环调节的形态特征及影响因素。方法：形态测量法分期观察肝硬化门脉高压（LC－PHT）模型鼠胃粘膜微血管直径（DGMM）和粘膜下小静脉管径比（PSmVD）的改变及其与门脉压力（PVP）和肝功状态的关系。结果：（1）LC－PHT鼠DGMM和PSmVD均明显增大（P＜0．05及0．01）。（2）DGMM和PSmVD改变主要见于LC－PHT－Ⅱ鼠（P＜0．05及0．01），LC－PHT－Ⅰ鼠则与对照组无差异。（3）PSmVD变化比DGMM变化更严重且发生较早，尤其LC－PH－TⅡ鼠PSmVI明显大于LC-PHT-Ⅰ鼠（P＜0．05）。（4）DGMM和PSmVD改变与PVP及肝功改变有关，但与GPT升高和白蛋白降低同步发生，而与PVP、球蛋白及白／球蛋白比值变化不同步。（5）PSmVD与DGMM间有正相关关系（r=0．747，P＜0．001）。结论：胃微血管系统尤其粘膜下静脉扩张瘀血是慢性型门脉高压条件下胃微循环调节反应的主要形态特征。它是缓慢而连续发展的，并主要见于门脉高压病程的相对晚期，与门脉高状态的持续存在和进展，以及肝功能状态和胃微血管肾节的自身可变性有关。推测胃粘膜下动-静脉短路的开放增多对胃微血管尤其粘膜下静脉扩张瘀血有重要促进作用。

Objective: To investigate the morphological characters and influencing fac tors of the edjustment response in the gastric microcirculation during the develop ment of liver cirrhosis and portal hypertension(LC-PHT) in rats. Methods: A technique of morphological measuration was utilized, with two stages, to ob serve the changes of the gastric microvascular system(GMS) in LC-PHT rats re duced by TAA injection. Changes of portal venous pressure(PVP) and hepatic function were also measured. Resultst:① The diameter of gastric mucosal mi crovessels (DGMM ) and the proportion of submucosal venules diameter (PSmVD) were increase in LC-PHT rats(P＜0.05 and 0. 01 ). thence an ob vious congestion in GMS was observed. ② Ectasias and congestion in GMS were mainly showed in LC- PHT-Ⅱ rats (P＜ 0. 05 and 0.01 ).③ There is rather severe changing of PSmVD than that of DGMM and especially the PSmVD in LC-PHT-Ⅱ rats was larger than that in LC-PHT-1 rats (P＜0. 05). ④ Increasing of DGMM and PSmVD occured simultaneously with changing of GPT and ALB but did not with PVP and A/G. ⑤ There was a posi tive relation between PSmVD and DGMM in LC-PHT rats (r = 0. 747. P＜0. 001 ). Conclusions: Ectasias and congestion in GMS are the main morphologi Cal characters of the adjustment responses in the gastric microcirculation to the status of chronic PHT. The changing course developes chronically and continu ously, and occurs mainly in a relative later stage. It is influenced mainly by both maintaining and advancing of PHT, without excepting the hepatic function and the changeability in GMS itself. It is likely to be rational, thence, to regard the existence of the submucosal arterovenous anastomoses resulted from PHT as an important factor advancing ectasias and congestion in GMS to a higher degree grdually.