内镜治疗对食管胃静脉曲张血管活性物质的影响及临床意义

Effect of endoscopic therapy on vasoactive substances in esophageal and gastric varices and its clinical significance

目的分析肝硬化食管胃静脉曲张内镜治疗前后血浆尾加压素Ⅱ(UⅡ)、内皮素(ET)、血管活性肠肽(VIP)的变化及临床意义。方法收集2017年6月-2019年11月河北工程大学附属医院消化内科病房收治的肝硬化门脉高压患者50例,根据肝功能分级标准,A级27例,B级18例,C级5例。按照不同内镜治疗方法分为套扎组(20例)、硬化组(21例)及联合治疗组(9例)。于内镜治疗前、治疗后1 d、7 d测定各组患者血浆UⅡ、ET和VIP水平,分析内镜治疗前后血浆UⅡ、ET和VIP水平的变化。结果内镜治疗前,Child-pugh A、B、C级患者血浆UⅡ、ET、VIP水平比较差异均有统计学意义(P<0.05);与治疗前比较,治疗后1 d、7 d不同Child-pugh分级患者血浆UⅡ、VIP水平均无变化(P>0.05);Child-pugh A、B级患者ET治疗后1 d、7 d与治疗前比较差异无统计学意义(P>0.05);Child-pugh C级患者ET治疗后1 d与治疗前比较差异无统计学意义(P>0.05),治疗后7 d与治疗前比较差异有统计学意义(P<0.05)。套扎组、硬化组、联合治疗组治疗前后血浆UⅡ、ET、VIP水平均无变化(P>0.05)。结论食管胃静脉曲张不同内镜治疗方法对血浆UⅡ、ET、VIP水平无明显影响,内镜治疗前后对门静脉血流动力学无明显影响。

Objective To analyze the changes and clinical significance of plasma urotensin(UⅡ),endothelin(ET and vasoactive intestinal peptide(VIP)before and after endoscopic treatment of cirrhotic esophagus and gastric varices.Methods 50 cases of cirrhotic portal hypertension admitted to the Department of Gastroenterology,Affiliated Hospital of Hebei Engineering University from June 2017 to November 2019 were collected.According to the liver function grading standard,there were 27 cases of grade A,18 cases of grade B and 5 cases of grade C.According to different endoscopic treatment methods,the patients were divided into ligation group(20 cases),sclerotherapy group(21 cases)and combination therapy group(9 cases).In endoscopy before and after treatment 1 d,7 d to,determine each group patients plasma UⅡET and VIP level,Analysis of endoscopic before and after treatment plasma UⅡET and VIP level changes.Results Child-pugh before endoscopic treatment for patients with grade A,B,C plasma UⅡ,ET and VIP level comparative differences were statistically significant(P<0.05);Compared with before treatment,after treatment 1 d,7 d different Child-pugh,classifying patients plasma UⅡ,VIP levels had no significant change(P>0.05);Child-pugh,A and B ET level in patients with 1 d,7 d after treatment were no statistically significant difference compared with before treatment(P>0.05);Child-pugh C ET level after treatment in patients with 1 d was no statistically significant difference compared with before treatment(P>0.05),7 d after treatment compared with before treatment difference was statistically significant(P<0.05).Ligation group,hardening,combined treatment group before and after treatment,had no significant change in the level of plasma UⅡ,ET,VIP(P>0.05).Conclusion Different endoscopic treatments for esophageal and gastric varices have no significant effect on plasma UⅡ,ET,VIP levels,and no significant effect on portal hemodynamics before and after endoscopic treatment.