肝硬变门静脉高压症患者门体分流术前后血中内皮素、血栓素与前列环素动态临床观察

DYNAMIC OBSERVATION ON ET、TXA_2 AND PGI_2 IN CIRRHOTIC PATIENTS WITH PORTAL HYPERTENSION DURING PERIOPERATIVE PERIOD OF PORTASYSTEMIC SHUNT

目的 了解肝硬变门静脉高压症患者、液递物质代谢紊乱及其血流动力学后果。方法 对 30例肝硬变门静脉高压症患者门体分流术前后门脉血中内皮素 (ET)、血栓素 (TXA2 )和前列环素 (PGI2 )进行了水平变化动态临床观察。结果 在门静脉高压症患者门脉血中无论是缩血管物质 (ET、TXA2 )还是扩血管物质 (PGI2 )浓度均比胃肠对照者明显升高 (ERT:10 7.86± 2 5 .92 pg/ml,48.11± 9.40 pg/ml,P=0 .0 0 0 ;TXA2 :34 9.6 7± 198.41pg/ml,15 6 .2 7± 5 4.0 1pg/ml,P=0 .0 0 0 ;PGI2 :46 3.14± 10 8.2 5 pg/ml,2 2 7.2 3± 46 .19pg/ml,=0 .0 0 0 ) ,且二者浓度在门体分流术后均下降 (P=0 .0 0 2 )。结论 门静脉血中内皮素水平的增高对肝硬变患者门脉血管阻力的增加有重要影响 ,并对门静脉高压症的发病机理起重要作用。在肝硬变门静脉高压这一特殊病理生理状态下 ,缩血管物质与扩血管物质之间可能达成一种新的动态平衡。

Objective To study the role of the endothelin system in the pathogensis of volume and hemodynamic disturbances of cirrhosis.Methods We observed perioperative plasma vasoconstrictoe and vasodilator in 30 patients with portal hypertensive cirrhosis who undergoing portasystemic shunt.Results Both portal plasma vasoconstrictor(ET,TXA 2) and vasodilator(PGI 2) were higher in portal hypertensive cirrhotic patients than that in control subjects(ET:107.86±25.92pg/ml,48.11±9.40pg/ml,P=0.000;TXA 2:349.67±198.41pg/ml,156.27±54.01pg/ml,P=0.000;PGI 2:463.14±108.25pg/ml,227.23±46.19pg/ml,=0.000),and their concentrations decreased significantly in patients after portasystemic shunt(P=0.002).Condusion These results suggest that the elevated endothelin level has a significant influence on the portal vascular resistance of cirrhotic liver in vivo and has an important role in the patogenesis of portal hypertension.It could be that a new dynamic balance between vasoconstrictor and vasodilator is estabilshed in the pathophysiology of portal hypertensive cirrhotic patients after portasystemic shunt.