门静脉高压症病人肠道通透性、NO和内毒素的研究

A study on intestinal permeability, nitric oxide and endotoxin in patients with portal hypertension

目的 观察门静脉高压症病人的门静脉压力、肠道通透性、NO和内毒素水平 ;并分析它们之间的相互关系。方法 门静脉高压症病人 2 0例 ,分别检测肠道通透性、门静脉压力和外周血中NO和内毒素浓度。另有 2 0位健康志愿者作对照。结果 门静脉高压症病人较健康志愿者的肠道通透性 (0 132± 0 110vs 0 0 32± 0 0 18,P <0 0 1) ,外周血的NO浓度 (38 77± 13 71vs 2 1 77±3 0 1μmol/L ,P <0 0 0 1)和内毒素浓度 (0 5 7± 0 18vs 0 11± 0 0 5EU/ml,P <0 0 0 1)均非常明显的升高。研究还发现门静脉压力和这三者均有显著相关性 (r >0 45 ,P <0 0 5 ) ,另外肠道通透性与内毒素浓度 (r=0 5 2 9,P <0 0 5 )也存在相关性 ,而与NO浓度则无相关性 ;内毒素和NO之间没有发现相关性。结论 研究表明门静脉高压症病人肠道通透性、NO和内毒素水平显著升高。门静脉压力和这三者的显著相关说明门静脉压力升高是导致肠道通透性升高的直接因素 ,而内毒素和NO的升高维持了门静脉的高动力循环。

Objective To investigate portal pressure, intestinal permeability and the levels of endotoxin and nitric oxide (NO) in patients with portal hypertension. Methods Intestinal permeability was assessed in 20 patients with portal hypertension and 20 healthy individuals. Blood samples were taken from peripheral vein in all the patients and controls. Levels of NO and endotoxin were also determined. Portal pressure was measured upon operation. Results Intestinal permeability and concentrations of endotoxin and NO were significantly higher in patients than in the controls (0.132±0.110 vs 0.032±0.018, P<0.01;38.77±13.71 vs 21.77± 3.01 umol/l, P<0.001;0.57±0.18 vs 0.11±0.05 EU/ml, P<0.001;respectively). Portal pressure was significantly correlated to intestinal permeability and levels of NO and endotoxin (r>0.45, P<0.05). Intestinal permeability was significantly correlated with endotoxin level (r=0.529, P<0.05) but not with NO level. Furthermore, NO level was not markedly correlated to endotoxin level. Conclusions Intestinal permeability and levels of endotoxin and NO are increased in patients with portal hypertension. These three indexes are significantly correlated to portal pressure, which indicates that portal pressure plays an important role in change of intestinal permeability. Meanwhile, the increased levels of endotoxin and NO maintain portal hyperdynamic circulation.