肝硬化患者肝切除术后肝脏再生的临床研究

Liver regeneration after partial hepatectomy in patients with liver cirrhosis

目的 研究肝硬化患者肝切除术后肝脏再生相关因子的变化规律以及其与术后残肝再生之间的关系.方法 选取2007年6月至2009年8月35例行肝切除术患者,根据有无肝硬化分为肝硬化组（16例）和非肝硬化组（19例）.分别于术前、术后行计算机断层血管造影术测量肝脏体积大小,计算残肝再生率.测定肝细胞生长因子（HGF）和血管内皮生长因子（VEGF）变化,同时观察术后患者肝功能变化.结果 肝硬化组术后肝功能受损较为严重,且恢复缓慢.非肝硬化组术后7、30、90d残肝再生率分别为（63.6±15.9）%、（79.4±17.2）%、（97.2±18.3）%,均明显高于肝硬化组[分别为（41.7±10.7）%、（55.7±13.2）%、（76.6±12.5）%]（P〈0.05）.肝硬化组术后1、3、7dHGF水平均明显高于非肝硬化组（P〈0.05）,而VEGF水平却低于非肝硬化组.结论 肝硬化患者合成VEGF能力下降,导致肝硬化肝切除术后肝脏再生较为缓慢.然而,临床中使用VEGF促进肝硬化患者肝脏再生还有待进一步研究.

Objective To investigate the changes of hepatocyte growth factor （HGF） and vascular endothelial growth factor（VEGF） after partial hepatectomy in patients with liver cirrhosis and their relationship with liver regeneration. Methods Thirty-five patients with partial hepatectomy between June 2007 and August 2009 were enrolled,according to whether cirrhosis were divided into cirrhosis group （16 cases） and non-cirrhosis group （19 cases）. Liver size were measured with angiographic computed tomography at 7,30,90 d after operation. Regeneration rate of remnant liver were calculated. The serum concentrations of HGF and VEGF were meaaured. Postoperative hepatic function and complications incidence rate were comparatively analyzed. Results Compared with non-cirrhosis group, the postoperative hepatic function of cirrhosis group suffered serious damage. In non-cirrhosis group, the remnant liver regeneration rate reached （63.6± 15.9）%, （79.4 ± 17.2）%, （97.2 ± 18.3）% at 7,30,90 d after operation,in cirrhosis group,it reached （41.7 ± 10.7）%, （55.7 ± 13.2）%, （76.6 ± 12.5）%, liver in non-cirrhosis group regenerated rapidly （P 〈0.05）. After hepatectomy,the HGF levels in cirrhosis group increased significantly at 1,3,7 d than those in non-cirrhosis group（P 〈 0.05）, but the VEGF levels were lower. Conclusions Liver in the patients with cirrhosis regenerate slowly and it may be due to in part through a decrease in VEGF. Whether it may,when given therapeutically represent a strategy to optimize liver regeneration in problematic patients needs to be clarified.