奥曲肽影响食管胃底静脉曲张破裂出血患者血清VEGF、NO、ET水平的表达及疗效观察

Influence of octreotide on expression of serum VEGF, NO and ET Level of patients with esophageal and gastric varicose bleeding and observation of curative effects

目的探讨奥曲肽对食管胃底静脉曲张破裂出血(EGVB)患者血清中血管内皮生长因子(VEGF)、一氧化氮(NO)、内皮素(ET)等水平的影响及临床疗效。方法回顾性分析50例EGVB患者随机分为奥曲肽组25例和垂体后叶素组25例,另选择年龄匹配的20例健康对照组。奥曲肽组给予首剂奥曲肽100μg+0.9%氯化钠溶液20m L静注,继之以奥曲肽25μg/h微泵持续静滴,24h后改用垂体后叶素0.1u/min微泵静滴至48h;垂体后叶素组单用垂体后叶素以0.2u/min微泵持续静滴72h。观察两组患者止血情况、输血量等指标,同时测定治疗前三组及经72h治疗后两组EGVB患者血清中VEGF、NO、ET水平的含量。结果与对照组比较,EGVB患者血清中VEGF、NO和ET水平均明显高于正常对照组(P<0.05);经72h治疗后,两组患者血清VEGF、NO、ET的水平较治疗前明显下降(P<0.01),奥曲肽组下降更显著(P<0.05);且奥曲肽组止血情况、平均输血量、临床疗效均明显优于垂体后叶素组,两组比较差异有统计学意义(P<0.05)。结论奥曲肽序贯疗法对EGVB患者的止血效果显著,明显降低门静脉压力,疗效确切、安全、不良反应少,其协同止血作用可能是通过降低EGVB患者血清中炎症介质水平的异常表达起到关键性作用。

Objective To explore Influence of Octreotide on serum Vascular endothelial growth factor （VEGF）, Nitric oxide （NO） and Endothelin （ET） level of patients with Esophageal and gastric varicose bleeding （EGVB） and observation of curative effects. Methods Retrospective analysis. 50 EGVB patients were randomly allocated to the octreotide group and the pituitrin group, with 25 in each. 20 healthy people of the same age were set as the control group. Patients in the octreotide group were given first-dose of 100μ g＋0.9% of octreotide and 2OraL of sodium chloride solution by intravenous injection, then continuous intravenous injection of octreotide 25μg/h by micro-pump for 24 hours followed by intravenous injection of pituitrin 0.1u/min by micro-pump until 48 hours. Patients in the pituitrin group were only received continuous intravenous injection of pituitrin 0：2u/rain by micro-pump for 72 hours. Hemostatic condition, transfusion volume and other indexes of two groups were compared. At the same time, contents of serum VEGF, NO and ET level before treatment and after 72-hour treatment of EGVB patients in three groups were detected. Results Serum VEGF, NO and ET level of EGVB patients was significantly higher than that in the control group （P 〈 0.05）. Serum VEGF, NO and ET levels of patients in two groups were all significantly decreased after the treatment （P〈0.01） and those in the octreotide group were decreased more significantly （P 〈 0.05）. In addition, hemostatic condition, average transfusion volume and clinical curative effects of the octreotide group were all significantly superior to those of the pituitrin group. Differences of two compared groups have statistically significance （P 〈 0.05）. Conclusion Octreotide sequential therapy has an obvious hemostatic effect and it can reduce portal pressure which has an acute and safe curative effect and few adverse reactions. Its collaborative hemostatic effect may be due to that reduction of abnormal expressions of serum inflammatory mediators of EGVB patients plays a leading role.