内毒素血症与梗阻性黄疸病人肾功能损害的关系

The clinical study of plasma endotoxin on renal injury in patients with obstructive jaundice

目的 :探讨梗阻性黄疸 (梗黄 )病人血浆内毒素 (ET)水平与肾功能的关系。方法 :动态观察 30例梗黄 (梗黄组 )手术前后血浆ET、肌酐 (Cr)、尿素氮 (BUN)含量及内生肌酐清除率 (Ccr)变化 ,并与 2 1例无黄疸病人 (对照组 )进行同步比较。结果 :梗黄组外周血ET水平显著升高 (P <0 .0 1) ,Ccr显著降低 (P <0 .0 1) ;门静脉血ET水平又显著高于外周血 (P <0 .0 5 ) ,术后 5d内ET水平降低不明显 ;术后第 1天ET反而升高 (P<0 .0 5 ) ,Ccr更趋下降 (P <0 .0 5 ) ,并伴有血Cr、BUN升高 (P <0 .0 5 ) ;5d后随ET水平逐渐下降 ,Ccr逐步上升 ,第 15天ET、Ccr两项指标接近正常水平 ;ET与Ccr呈显著负相关 (r=- 0 .5 5 ,P <0 .0 5 )。对照组血浆ET呈低水平 ,Ccr在 10 0ml/min左右 ,手术前后变化均不显著 (P >0 .0 5 )。结论 :肠源性内毒素血症是梗黄肾功能损害的重要原因 。

Objective:To study the relationship between plasma endotoxin(ET) level and renal damage in patients with obstructive jaundice(OJ).Methods:The level of plasma ET?creatinine(Cr) or blood urea nitrogen(BUN) and endogenous creatinine clearance rate(Ccr) were determined in 30 patients with OJ. Other 21 cases of chronic cholelithiasis without jaundice were employed to serve as the control.Results:The plasma ET level of peripheral blood was increased significantly(P<0.01) and Ccr level was decreased markedly(P<0.01) in group OJ than in the control on the 1st day of hospitalization. In group OJ,the plasma ET level in portal vein blood was higher markedly than in peripheral blood(P<0.05),five days after operation,plasma ET level decreased and Ccr increased significantly. ET and Ccr approached to normal at 15 days after operation. However,ET level increased significantly and Ccr decreased markedly at the 1st day after operation in group OJ. ET had negative correlation with Ccr significantly(r=-0.55,P<0.05).Conclusion:Gut derived endotoxin was one of the important causes of renal injury in patients with OJ,especially in one week after operation.