乌司他丁对门脉高压症出血病人肝功能的保护作用

Protective effects of ulinastatin on liver function in portal hypertensive patients with hemorrhage

目的 探讨门脉高压症出血病人肝功能变化情况 ,同时评价应用乌司他丁 (Ulinastatin ,UTI)治疗的效果。方法 将 4 6例肝硬化门脉高压症出血病人分为两组 :Ⅰ组 (n =2 2 )为一般治疗组 ,Ⅱ组 (n =2 4 )为UTI治疗组 ,分别检测Ⅰ、Ⅱ组出血后 1,2 ,4 ,7,10 ,14d血ET变化情况 ,并检测1,7,14d的肝功能。另选肝硬化门脉高压症未出血病人 (n =2 0 ) ,检测血浆ET ,作为对照组。结果 出血后 7,14d ,Ⅰ、Ⅱ组总胆红素 (TBIL)均呈先升高后下降 ,但Ⅱ组较Ⅰ组下降快 (分别P <0 0 5 ,P <0 0 1)。ALT、AST亦呈先升高后下降 ,但于出血后 14日Ⅱ组较Ⅰ组下降快 (P <0 0 5 )。Ⅰ、Ⅱ组出血后 1d血ET浓度较对照组显著升高 (P <0 0 1) ,随后逐步下降。Ⅱ组ET下降较Ⅰ组快 ,于出血后 2d(P <0 0 5 )、4d (P <0 0 1)、7d(P <0 0 5 )有显著差异。出血后 1dⅠ、Ⅱ组ET浓度与TBIL呈正相关 (r=0 734,P <0 0 1) ;Ⅰ、Ⅱ组血ET下降指数与TBIL增高指数呈负相关 (r =- 0 4 86 ,P <0 0 5 )。结论 肝硬化门脉高压症大出血后应用UTI治疗可抑制TBIL、ALT、AST、ET等的升高 ,起到保护肝脏功能的作用。

Objective To investigate variations of liver function and evaluate the therapeutic effects of ulinastatin (UTI) in portal hypertensive patients with esophageal variceal hemorrhage. Methods A total of 46 patients with portal hypertension were divided into 2 groups. The patients in group A ( n =22) received general therapy and those in group B (n =24) received the general therapy and UTI after hemorrhage. The plasma ET concentration was measured on the 1st, 2nd, 4th, 7th, 10th and 14th d and liver function determined on the 1st, 7th and 14th d after the hemorrhage. Other 20 patients without the hemorrhage were employed to serve as the control group. Results ON the 7th and 14th d after hemorrhage, the levels of TBIL, ALT and AST were elevated firstly and then decreased in groups A and B. The decrease of TBIL, ALT and AST levels was significantly faster in group B than in group A ( P <0.05 and 0.01) on the 14th d after hemorrhage. On the 1st day after the hemorrhage, the ET concentration was markedly increased in groups A and B as compard with the control group ( P <0.01). Then it was gradually decreased on the 10th d after hemorrhage. Meanwhile, the ET concentration was positively correlated to TBIL level in groups A and B ( r=0.734, P<0.01) and the decrease index of ET concentration was negatively correlated to increase index of TBIL in the 2 groups ( r=-0.486, P <0.05). Conclusions UTI can protect liver function by inhibiting increase of ALT, AST and TBIL levels in portal hypertensive patients with hemorrhage.