分阶段联合介入术对门静脉高压症患者Rho表达的影响

Effects of phased joint intervention on Rho expression of patients with portal hypertension

目的探讨分阶段联合介入术治疗门静脉高压症并发食管静脉曲张出血和脾功能亢进的临床疗效及对Rho-ROCK表达的影响。方法采用分阶段联合介入术(PTVE+PSE)治疗53例肝硬化门脉高压症并发食管静脉曲张出血和脾功能亢进患者,分析治疗前后血常规、肝功能等。实时PCR检测分阶段联合介入术前后PBMC中Rho、ROCK1和ROCK2的表达,Western印迹观察分阶段联合介入术前后PBMC中Rho、ROCK1、ROCK2、磷酸化肌球蛋白磷酸酶1(p MYPT1)及总MYPT1(tMYPT1)蛋白表达情况。结果术后急诊止血率达100%;术后曲张静脉消失、WBC、PLT明显上升,治疗后1、4、6个月与治疗前相比,均明显好转(P<0.05);术后Alb明显上升,TBil、INR下降,与治疗前相比,明显好转(P<0.05)。术后无严重并发症。术前及术后,Rho、ROCK1、ROCK2 mRNA表达均高于正常对照组(P<0.01),术后组的Rho、ROCK1、ROCK2 mRNA表达明显低于术前组(P<0.01)。术后组Rho、ROCK1、ROCK2、p MYPT1蛋白表达较术前明显下调。结论分阶段联合介入术能有效治疗食管静脉曲张出血、脾功能亢进及改善肝功能,其疗效可能与影响调控Rho-ROCK信号通路相关。

Objective To investigate the clinical efficacy and Rho/ROCK expression of patients treated with phased joint intervention,which with portal hypertension complicated by esophageal variceal bleeding and hypersplenism.Methods Fifty-three patients with portal hypertension caused by liver cirrhosis and complicated by esophageal variceal bleeding and hypersplenism were reviewed.All of the patients were treated with percutaneous transhepatic variceal embolization （PTVE）plus transcatheter splenic arterial embolization （PSE）.Blood routine,liver function,etc,were analyzed.Peri-pheral blood mononuclear cells （PBMCs）were separated and prepared;Rho,ROCK1 and ROCK2 expression levels were tested by real time PCR in PBMCs before and after phased joint intervention;Western Blot was applied for observing protein expression of Rho,ROCK1 ,ROCK2,phosphorylated MYPT1 （p MYPT1 ）and total MYPT1 （t MYPT1 ）from PBMC before and after phased joint intervention.Results There were 53 cases of emergency hemostasis and emergency hemostasis rate was 100%,and varicose veins disappeared after operation.There was a significant increase in levels of white blood cells and platelets after operative,which was improved markedly （P＆lt;0.05 ）1 ,4 and 6 months after treatment,respectively. Higher albumin and lower total bilirubin and INR were observed after intervention,and these parameters were improved significantly （P＆lt;0.05）1 ,4 and 6 months after treatment.No serious postoperative complications were found.Preopera-tive and postoperative expression levels of Rho,ROCK1 and ROCK2 mRNA were higher than those of normal control group （P＆lt;0.01）.Expression levels of Rho,ROCK1 and ROCK2 mRNA of postoperative group were significantly lower than those of preoperative group （P＆lt; 0.01 ）.Compared to preoperative group,protein expression levels of Rho,ROCK1 , ROCK2 and pMYPT1 of postoperative group reduced obviously.Conclusion Phased joint intervention can effectively treat＆amp;nbsp;esophageal variceal bleeding and hypersplenism,and improve liver function,of which efficacy may be associated with the signaling pathways of regulating Rho-ROCK.