乌司他丁联合硫酸镁预处理对肝缺血再灌注损伤的保护作用

Protective effect of ulinastatin combined with magnesium sulfate pretreatment on hepatic ischemia reperfusion injury

目的观察探讨乌司他丁联合硫酸镁预处理对肝门阻断肝部分切除患者肝缺血再灌注损伤的保护作用。方法选取100例第一次行肝门阻断肝部分切除术患者,随机分为对照组(Control组)、乌司他丁组(UTI组)、硫酸镁组(MgSO_(4)组)和乌司他联合硫酸镁组(UTI+MgSO_(4)组),每组25例,观察各组患者术前、术毕以及术后1、3、5 d ALT、AST和SOD、MDA水平的变化。结果与Control组相比,术后第5天UTI+MgSO_(4)组ALT水平明显降低(P<0.05),而其余时间点各组ALT水平的表达无明显差异;术后第1天UTI组、MgSO_(4)组、UTI+MgSO_(4)组AST水平升高幅度明显较小(P<0.05);术后第5天,UTI组、MgSO_(4)组、UTI+MgSO_(4)组AST水平明显下降(P<0.05),且UTI+MgSO_(4)组较UTI组、MgSO_(4)组下降更为显著(P<0.05);术毕时UTI组、MgSO_(4)组、UTI+MgSO_(4)组SOD水平均较对照组明显升高(P<0.05),且UTI+MgSO_(4)组较单一用药组差异更为显著(P<0.05);随后在术后第1天、第3天UTI+MgSO_(4)组SOD水平高于其余3组(P<0.05);而术前、术后第5天各组间无明显差异;术毕时UTI组、MgSO_(4)组、UTI+MgSO_(4)组MDA水平升高幅度明显较对照组小(P<0.05);术后第1天UTI+MgSO_(4)组MDA水平较其余三组明显降低(P<0.05),而术前、术后第3、5天各组间无明显差异。结论乌司他丁联合硫酸镁预处理可明显减轻肝缺血再灌注损伤,且效果较单一用药更为显著。

Objective To observe the protective effect of ulinastatin combined with magnesium sulfate pretreatment on hepatic ischemia reperfusion injury in patients with partial hepatectomy after hilar occlusion.Methods 100 patients who underwent the partial hepatectomy with hepatic portal occlusion for the first time were randomly divided into control group,ulinastatin group(UTI group),magnesium sulfate group(MgSO_(4) group)and ulinastatin combined with magnesium sulfate group(UTI+MgSO_(4) group),with 25 cases in each group.The serum levels of ALT,AST,SOD and MDA in each group were detected before,after operation and 1,3 and 5 days after surgery.Results Compared with the control group,the level of ALT in UTI+MgSO_(4) group significantly decreased on the 5th day after operatione(P<0.05),while there was no significant difference in the expression of ALT level at other time points among the groups.On the first day after operation,the increase of AST level in UTI group,MgSO_(4) group and UTI+MgSO_(4) group was significantly smalle(P<0.05).On the 5th day after operatione,the level of AST in UTI group,MgSO_(4) group and UTI+MgSO_(4) group decreased significantly(P<0.05),and the level of ASTin UTI+MgSO_(4) group decreased more significantly than that in UTI group and MgSO_(4) group(P<0.05).The level of SOD in UTI group,MgSO_(4) group and UTI+MgSO_(4) group was significantly higher than that in the control group(P<0.05),and the difference was more significant in UTI+MgSO_(4) group than in the monotherapy group(P<0.05).The level of SOD in UTI+MgSO_(4) group was higher than that in the other three groups on the 1st and 3rd after operation(P<0.05).There was no significant difference between the groups before operation and the 5th day after operation.At the end of operation,the increase level of MDA in UTI group,MgSO_(4) group and UTI+MgSO_(4) group were significantly less than that in control group after operation(P<0.05).On the 1st day after operation,MDA level in UTI+MgSO_(4) group was significantly lower than that in the other three groups(P<0.05).There was no significant difference among the groups before operation,3 and 5 days after operation.Conclusion Ulinastatin combined with magnesium sulfate pretreatment can significantly reduce hepatic ischemia-reperfusion injury,and the effect is more significant than that of monotherapy.