梗阻性黄疸手术前后内毒素水平和肾功能变化

Changes of plasma endotoxin on renal damage in patients with obstructive jaundice before and after operation

目的 探讨梗阻性黄疸 (梗黄 )患者血内毒素 (ET )水平与肾功能的关系。方法 观察 30例梗黄患者 (梗黄组 )手术前后血ET含量及肾功能变化 ,并与 2 1例无黄疸患者 (对照组 )进行同步比较。结果 术前梗黄组外周血ET水平明显升高 (P <0 .0 1) ,门静脉血ET水平明显高于外周血 (P <0 .0 5 ) ,内生肌酐清除率 (Ccr)明显降低 (P <0 .0 1)。术后第 1dET反而升高 (P <0 .0 5 ) ,Ccr术后 1d更趋下降 (P <0 .0 5 ) ,并伴有血肌酐、尿素氮升高 (P <0 .0 5 ) ;5d后随ET水平逐渐下降 ,Ccr逐步上升 ,第 15dET ,Ccr两项指标接近正常水平 ;ET与Ccr呈显著负相关 (P <0 .0 5 )。对照组手术前后血ET均呈低水平变化。

Objective To study the relationship of plasma endotoxin (ET) level and renal function damage in patients with obstructive jaundice(OJ). Method The level of plasma ET、creatinine (Cr) or blood urea nitrogen ( BUN ) and endogenous creatinine clearance rate (Ccr ) were determined before and after operation in 30 patients with OJ(OJ group), and 21 cases of chronic cholelithiasis without jaundice (control group). Results The plasma ET level of peripheral blood was increased more significantly (P<0.01)and Ccr level was decreased more markedly (P<0.01) in OJ group than those in the control group before the operation. In OJ group ,the plasma ET level was markedly higher in portal vein blood than that in peripheral blood (P<0.05).In OJ group,plasma ET level increased more and Ccr decreased more on 1 day,after the operation,but 5 days after operation,ET level decreased and Ccr increased significantly. ET and Ccr two parameters approached to normal on 15 days postoperatively. ET had significant negative correlation with Ccr ( P<0.05). Conclusions Gut-derived endotoxin was one of the important causes of renal damage in patients with OJ.