摘要
目的探讨断流术对慢性乙型肝炎导致的门静脉高压症患者肝储备功能及肝硬化病程的影响和可能机制。方法选择30例HBsAg(+)、HBV-DNA(-)、肝功能Child-Pugh A或B的门静脉高压症患者,分别于断流术前后测定血小板计数及总胆汁酸(TBA)、胆碱酯酶(CHE)、前白蛋白(PA)和总胆固醇(CHOL)等肝储备功能指标;ELISA法测定细胞因子HGF和TGF-β1;化学发光免疫法测定透明质酸(HA)、三型前胶原N端肽(PC-III)、四型胶原(IV-C)、层粘连蛋白(LN)。结果①血小板术后快速回升,至术后2周达高峰,然后缓慢下降,术后半年稳定在(169±27)×109。②肝储备功能术后轻度下降,至术后2周恢复术前水平,术后3个月及半年较术前明显改善。③断流术后3个月及半年,HGF与TGF-β1较术前均明显下降,同时HA、PC-III、IV-C、LN较术前明显降低。结论断流术可改善肝脏储备功能,使肝纤维化血清学指标和细胞因子含量下降,有助于控制肝硬化患者病情。
Objective To investigate the effects and potential mechanisms of splenectomy plus esophagogastric devascularization on hepatic functional reserve and cirrhotic progress of portal hypertensive patients with hepa- titis B. Methods Thirty consecutive portal hypertensive patients with positive HBsAg and negative HBV-DNA and Child-Pugh A or B were collected in this study. The platelet counts and hepatic functional reserve markers, such as total bile acids, cholinesterase, prealbumin, total cholesterol before and after surgery were analyzed. Hepatic growth factor （HGF） and transform growth factor-betal （TGF-β1） were measured with ELISA and Chemiluminescence immunoassay was used to test hyaluronic acid （HA）, N-terminal type Ⅲ procollagen peptide （PC-Ⅲ）,collagen type four （Ⅳ-C） and laminin （LN）. Results Platelet counts rapidly rose and reached peak beyond normal in 2 weeks postoperatively, and then gently fell down to normal range, stabilized at （169±27）× 109 6 months postoperatively. Liver functional reserve was deteriorated somewhat within 2 weeks after surgery and recovered to preoperative condition in 2 weeks postoperatively and obviously improved at 3 and 6 months postoperatively. HGF and TGF-β1 significantly decreased in 3 and 6 months postoperatively; at the same time, HA, LN, pC-Ⅲ and Ⅳ-C also persistently declined after surgery. Conclusion Splenectomy plus devasculariza- tion could improve hepatic functional reserve, decline noninvasive hepatic fibrosis serum markers and cytokines, which contribute to inhibiting cirrhotic patients＇ condition.
出处
《肝胆胰外科杂志》
CAS
2013年第1期31-34,共4页
Journal of Hepatopancreatobiliary Surgery
基金
2010年度南京军区面上课题(10MA043)
关键词
脾切除
肝硬化
肝储备功能
肝细胞生长因子
转化生长因子β1
splenectomy
liver cirrhosis
hepatic functional reserve
hepatic growth factor
transform growth factor-betal
