前列地尔治疗肝肺综合征临床研究

Clinical study of prostaglandin in the treatment of patients with hepatopulmonary syndrome

目的观察前列地尔对肝肺综合征患者血浆ET-1、NO、TNF-α、PaO2水平的影响。方法选择肝硬化合并肝肺综合征患者60例,健康体检者30例。肝硬化合并肝肺综合征患者随机分为两组:对照组30例,试验组30例。对照组给予常规的保肝、支持、吸氧治疗,试验组在对照组治疗基础上每日加用前列地尔20μg,连用2周。检测各组患者血浆ET-1、NO、TNF-α、PaO2水平。结果对照组、试验组治疗前ET-1、NO、TNF-α水平较健康组显著升高,PaO2较健康组显著下降(P<0.05);对照组、试验组之间无显著性差异(P>0.05);试验组治疗前后血浆ET-1、NO、TNF-α、PaO2水平有显著性差异(P<0.05);试验组治疗后血浆ET-1、NO、TNF-α水平明显低于对照组治疗后水平,PaO2明显高于对照组治疗后水平,有显著性差异(P<0.05)。结论前列地尔可以通过显著降低肝硬化合并肝肺综合征患者血浆ET-1、NO、TNF-α水平来升高PaO2,是治疗肝硬化合并肝肺综合征的作用机制之一。

Objective To observe the influence of prostaglandin on plasma tumor necrosis factor-α（TNF-α）,nitric oxide（NO） and endothelin-1（ET-1） in patients with hepatopulmonary syndrome（HPS）.Methods Sixty patients with hepatopulmonary syndrome were randomly divided into test group and control group.Thirty healthy volunteers were enrolled.Standard medical treatment was arranged to control group and test group and an additional dosage of prostaglandin 20 μg once a day for two weeks was added to every patients in test group.Levels of TNF-α,NO, ET-1 and PaO2 in every group were measured.TNF-α was measured with solidphase-enzyme linked immunosorbent assay（ELISA）.NO was measured with nitrite reductase method and ET-1 was measured with radioimmunoassay（RIA）.Results Plasma levels of TNF-α,NO,ET-1 in patients with HPS in test group and control group before treatment were significantly higher than those in healthy volunteers,and the level of PaO2 in patients with HPS before treatment was significantly lower than that in healthy volunteers（P0.05）.No significant difference was indicated between test group treatment and control group before treatment（P0.05）.Plasma levels of TNF-α,NO,ET-1 significantly decreased,and the level of PaO2 significantly increased after prostaglandin injection in test group（P0.05）.Furthermore,plasma levels of TNF-α,NO,ET-1 were also significantly lower in test group than those in control group,the level of PaO2 was higher in test group than that in control group after prostaglandin injection（P0.05）.Conclusion Prostaglandin can reduce the levels of TNF-α,NO,ET-1 in patients with HPS,which may be involved in the mechanism of hepatopulmonary syndrome treatment.