摘要
目的探讨内皮素(ET)和一氧化氮(NO)在重型肝炎(SH)发病中的作用.方法检测30例SH,32例慢性肝炎(CH)患者外周血ET和NO代谢物NO-2的水平,并用NO合成酶底物左旋精氨酸(LArg)进行治疗前后对比.结果SH患者外周血ET和NO-2水平(139ng/L±14ng/L,127μmol/L±40μmol/L)明显高于CH组(85ng/L±15ng/L,63μmol/L±25μmol/L,P<001).合并有Ⅲ,Ⅳ期肝性脑病与肝肾综合征患者外周血ET和NO-2水平(149ng/L±13ng/L,162μmol/L±34μmol/L)明显高于非肝性脑病患者(115ng/L±12ng/L,88μmol/L±24μmol/L,P<001)和Ⅱ期肝性脑病患者(136ng/L±10ng/L,122μmol/L±26μmol/L,P<001);LArg静脉滴注后血浆ET水平和平均动脉压(MAP)显著下降,而肌酐清除率(cCr)和尿钠含量明显增加.结论ET和NO水平升高是引起SH多脏器功能障碍的重要因素.LArg长期治疗可能促进SH患者脑水肿形成和肝肾综合征发生.
AIM To investigate the role of endothelin (ET) and nitric oxide (NO) in pathogenesis of severe hepatitis. METHODS The peripheral blood levels of ET and NO - 2 (metabolite of NO) were measured in 30 patients with severe hepatitis and 32 patients with chronic hepatitis. L arginine (L Arg), a substrate for NO synthase, was infused into 9 patients with severe hepatitis, and the effects were compared with those of saline infusion. RESULTS ET and NO - 2 levels were significantly higher in patients with severe hepatitis ( 139ng/L ± 14ng/L , 12 7μmol/L ± 4 0μmol/L ) than those of chronic hepatitis ( 85ng/L ± 15ng/L , 6 3μmol/L ± 2 5μmol/L , P <0 01). ET and NO - 2 levels were markedly higher in severe hepatitis with stage Ⅲ and Ⅳ of encephalopathy and hepatic renal failure ( 149ng/L ± 13ng/L , 16 2μmol/L ± 3 4μmol/L ) than in those with stage Ⅱ of encephalopathy ( 136ng/L ± 10ng/L , 12 2μmol/L ± 2 6μmol/L , P <0 01) or without encephalopathy ( 115ng/L ± 12ng/L , 8 8μmol/L ± 2 4μmol/L , P <0 01). L Arg infusion significantly decreased plasma ET levels and mean artery pressure (MAP) while markedly increased creatinine clearance (cCr) and urinary sodium excretion. CONCLUSION The increases of ET and NO levels may be important factors involved in the pathogenetic process of severe hepatitis with multiple organ dysfunction, and long term infusion of L Arg in patients with severe hepatitis may bring about hepatic renal syndrome and cerebral edema.
出处
《世界华人消化杂志》
CAS
1999年第2期122-124,共3页
World Chinese Journal of Digestology
关键词
肝炎
内皮素
一氧化氮
血液
hepatitis
endothelin/blood
nitric oxide/blood