断流术对乙型肝炎肝硬化患者血清PDGF、CTGF及肝纤四项的影响

Influence of Disconnection on Serum PDGF,CTGF and Liver Fibrosis Four Items of Patients with Hepatitis B Liver Cirrhosis

目的探讨断流术对乙型肝炎肝硬化患者血清血小板衍生生长因子(PDGF)、结缔组织生长因子(CTGF)及肝纤四项的影响。方法选择2012年1月至2013年12月在公安县中医医院接受治疗的114例乙型肝炎肝硬化患者为研究对象,根据随机数字表法分为两组,断流术组57例采用断流术治疗,药物组57例采用药物治疗。对比两组患者治疗前后血清PDGF、CTGF以及"肝纤四项"中的透明质酸、前层粘连蛋白(LN)、Ⅲ型胶原蛋白、Ⅳ型胶原蛋白的水平,总胆红素、胆碱酯酶、前白蛋白以及白细胞、血小板等的水平。结果治疗后,两组患者血清PDGF、CTGF、透明质酸、LN、Ⅲ型胶原蛋白、Ⅳ型胶原蛋白以及总胆红素、胆碱酯酶、前白蛋白以及白细胞、血小板等的水平较治疗前有显著变化(P<0.05),断流术组PDGF、GTGF、透明质酸、LN、Ⅲ型胶原蛋白、Ⅳ型胶原蛋白、总胆红素均显著低于药物组[(187±8)ng/L比(204±9)ng/L、(22.1±1.2)μg/L比(25.6±1.4)μg/L、(215±48)ng/L比(245±59)ng/L、(123.3±31.4)ng/L比(150.5±38.2)ng/L、(11.0±3.0)ng/L比(13.1±3.2)ng/L、(165.4±32.1)ng/L比(189.2±37.3)ng/L、(14.3±4.4)μmol/L比(23.1±6.3)μmol/L],差异有统计学意义(P<0.05),而胆碱酯酶前白蛋白、白细胞、血小板高于药物组[(5.7±2.8)k U/L比(4.5±1.9)k U/L、(151.3±43.2)mg/L比(133.2±35.2)mg/L、(5.7±1.4)×109/L比(4.4±1.1)×109/L、(278.4±78.4)×109/L比(146.4±38.5)×109/L],差异有统计学意义(P<0.05)。结论采用断流术治疗乙型肝炎肝硬化能有效降低PDGF、CTGF的水平,降低肝纤维化的速度,并且对肝脏储备功能及凝血功能有不同程度的改善,值得临床推广应用。

Objective To explore the effects of disconnection on serum platelet derived growth factor（ PDGF）,connective tissue growth factor（ CTGF） and ＂ liver fiber four＂ of patients with hepatitis B liver cirrhosis. Methods Total of 114 cases of hepatitis B cirrhosis in Gong＇an County Traditional Chinese Medicine Hospital during Jan. 2012 and Dec. 2013 were selected as the research objects. According to the treatment methods,57 cases treated by disconnection were as disconnection group,57 cases treated by drugs were as drug group. The serum PDGF,CTGF and hyaluronic acid（ HA）,laminin（ LN）,collagen type Ⅲ（ CⅢ）,typeⅣ collagen（ CⅣ）,total bilirubin（ TBIL）,cholinesterase（ CHE）,prealbumin（ PA）,blood WBC,PLT levels of the two groups were compared before and after treatment. Results There were significant difference after treatment on serum PDGF,CTGF,HA,LN,PcⅢ,CⅣ,TBIL,CHE,PA,WBC,PLA（ P 〈0. 05）. The PDGF[（ 187 ± 8） ng/L vs（ 204 ± 9） ng/L],CTGF[（ 22. 1 ± 1. 2） μg/L vs（ 25. 6 ± 1. 4） μg/L],HA[（ 215 ±48） ng / L vs（ 245 ± 59） ng / L],LN[（ 123. 3 ± 31. 4） ng / L vs（ 150. 5 ± 38. 2） ng / L],C Ⅲ [（ 11. 0 ±3. 0） ng / L vs（ 13. 1 ± 3. 2） ng / L] and C Ⅳ [（ 165. 4 ± 32. 1） ng / L vs（ 189. 2 ± 37. 3） ng / L],TBIL[（ 14. 3 ± 4. 4） μmol/L vs（ 23. 1 ± 6. 3） μmol/L]of disconnection group were significantly lower than the drug group after treatment,the CHE [（ 5. 7 ± 2. 8） k U / L vs（ 4. 5 ± 1. 9） k U / L],PA[（ 151. 3 ± 43. 2） mg / L vs（ 133. 2 ± 35. 2） mg / L],WBC [（ 5. 7 ± 1. 4） × 109/ L vs（ 4. 4 ± 1. 1） × 109/ L] and PLT [（ 278. 4 ±78. 4） × 109/ L vs（ 146. 4 ± 38. 5） × 109/ L] were higher than the drug group,the differences were statistically significant（ P 〈0. 05）. Conclusion Disconnection can effectively reduce the PDGF,CTGF level,lower hepatic fibrosis speed,and improve the degree of liver reserve function and coagulation function,thus is worthy of clinical application.