腹水浓缩回输治疗失代偿期肝硬化患者肾血流和血清血管活性因子水平的变化

Efficacy of ascites concentration and reinfusion in treatment of patients with decompensated liver cirrhosis

目的研究腹水浓缩回输治疗失代偿期肝硬化患者疗效及对肾血流和血清血管活性因子的影响。方法2016年5月~2018年5月收治的102例失代偿期肝硬化患者,其中60例接受腹水浓缩回输治疗,42例接受常规治疗,观察2 w。使用超声检测肾主动脉(MRA)、叶间动脉(IRA)和段动脉(SRA)收缩期最大血流速度和舒张期最低血流速度,检测血清内毒素(LPS)、血栓素(TX)、白三烯(LT)、醛固酮(ALD)和心钠肽(ANP)水平。结果在治疗2 w末,观察组24 h尿量为(1864.9±206.5)ml,显著多于对照组【(1050.7±186.2)ml,t=5.366,P=0.000】;观察组腹水消退时间为(13.8±4.5)d,显著短于对照组【(20.3±8.0)d,t=5.011,P=0.000】;观察组MRA、IRA和SRA肾血管收缩期最大血流速度分别为(75.5±9.0)cm/s、(37.2±4.4)cm/s和(56.4±5.7)cm/s,显著快于对照组[分别为(71.4±8.5)cm/s、(35.2±3.9)cm/s和(52.3±5.0)cm/s,P<0.05];观察组舒张期最低血流速度分别为[(25.7±3.6)cm/s、(16.3±3.1)cm/s和(14.9±2.7)cm/s,显著快于对照组[分别为(22.3±3.7)cm/s、(14.2±2.6)cm/s和(12.0±2.6)cm/s,P<0.05];观察组血清LPS、TX、LT和ALD水平分别为(10.6±1.8)pg/ml、(95.2±14.5)pg/ml、(88.4±7.7)pg/ml和(189.6±12.4)pg/ml,均显著低于,而血清ANP水平为(347.1±60.4)ng/L,显著高于对照组【分别为(13.2±2.1)pg/ml、(104.5±18.7)pg/ml、(94.7±8.5)pg/ml、(198.7±15.8)pg/ml和(271.3±44.7)ng/L,P<0.05】。结论采取腹水浓缩回输治疗失代偿期肝硬化患者近期消退腹水作用明显,可能与改善了肾血流量,调节了血管活性因子水平有关。

Objective The aim of this study was to observe the efficacy of ascites concentration and reinfusion(ACR)in treatment of patients with decompensated liver cirrhosis(DLC).Methods 102 patients with DLC and asciteswere admitted to our hospital between May 2016 and May 2018,and were divided into observation(n=60)and control(n=40)groups.The patients in the control were treated with routinesupporting therapy,and those in the observation were treated with ACR at base of general therapy.The maximum systolic and minimum diastolic blood flow velocities of main renal aorta(MRA),interlobular renal artery(IRA)and segmental renal artery(SRA)were measured by sonography.Serum levels of lipopolysaccharide(LPS),thromboxane(TX),leukotriene(LT),aldosterone(ALD)and atrial natriuretic peptide(ANP)were detected.Results At the end of two week treatment,the 24-hour urine volume in the observation group was(1864.9±206.5)ml,significantly greater than【(1050.7±186.2)ml,P<0.05】,and the ascites subsidence time in the observation group was(13.8±4.5)d,significantly shorter than【(20.3±8.0)d,t=5.011,P=0.000】in the control;the maximal systolic blood flow velocities of MRA,IRA and SRA inthe observation group were(75.5±9.0)cm/s,(37.2±4.4)cm/s and(56.4±5.7)cm/s,significantly quicker than【(71.4±8.5)cm/s,(35.2±3.9)cm/s and(52.3±5.0)cm/s,P<0.05】in the control group;the lowest diastolic blood flow velocities of MRA,IRA and SRA were(25.7±3.6)cm/s,(16.3±3.1)cm/s and(14.9±2.7)cm/s,much quicker than【(22.3±3.7)cm/s,(14.2±2.6)cm/s and(12.0±2.6)cm/s,P<0.05】in the control group;serum LPS,TX,LT and ALD levels in the observation were(10.6±1.8)pg/ml,(95.2±14.5)pg/ml,(88.4±7.7)pg/ml and(189.6±12.4)pg/ml,significantly lower than,while serum ANP level was(347.1±60.4)ng/L,much higher than in the control【(13.2±2.1)pg/ml,(104.5±18.7)pg/ml,(94.7±8.5)pg/ml,(198.7±15.8)pg/ml and(271.3±44.7)ng/L,P<0.05】.Conclusion The ACR therapy for cirrhotic patients with ascites is Efficacious,which might be related to the improved renal blood flow and modulation of renal vasoactive factors.