一氧化氮及内皮素在肝硬化患者肝损害中的作用及对肝门脉血流动力学的影响

王启之; 郑玉宝; 吴炎; 燕善军; 田怡

一氧化氮及内皮素在肝硬化患者肝损害中的作用及对肝门脉血流动力学的影响

Influence of nitric oxide and endothelin on levels of liver function and portal hyperdynamics in patients with liver cirrhosis

摘要

摘要: 目的: 探讨一氧化氮(NO)、内皮素(ET)对肝硬化患者肝损害及门脉血流动力学的影响。方法: 对51例肝硬化患者(其中Child-PughA、B、C级分别为19、21、11例)和31名正常对照分别用硝酸还原酶及放射免疫法检测血浆中NO、ET水平;用彩色多普勒检测受试对象门脉血流动力学的变化及用自动分析生化仪检测受试对象肝功能。结果: 肝硬化各组(Child-PughA、B、C级)血浆中NO、ET水平明显高于对照组(P<0.01);肝硬化各组患者血浆中NO、ET水平随肝功能恶化逐渐升高,各级之间比较差异均有统计学意义(P<0.01);在肝硬化患者血浆中NO/ET较对照组升高(P<0.01);NO/ET在Child-PughA、C级间差异有统计学意义(P<0.01),但在Child-PughB、C级间差异无统计学意义(P>0.05);肝硬化各组的门静脉血流量(PVBF)、脾静脉血流量(SVBF)显著高于对照组(P<0.01),肝硬化组Child-PughC级升高更明显,Child-PughC级与ChildPughA级比较差异有统计学意义(P<0.01),而Child-PughC级与B级比较差异无统计学意义(P>0.05);肝硬化组血浆中NO、ET含量与PVBF、SVBF呈显著正相关,而对照组与上述各递质间无直线相关关系。肝硬化有腹腔积液组患者NO、ET含量明显高于对照组(P<0.01)和无腹腔积液组(P<0.05)。结论: 肝硬化患者血浆中NO和ET水平可反映肝硬化的严重程度,对肝功能预测有重要意义。NO、ET在肝硬化门脉血流动力学紊乱的形成机制起着重要作用。

Abstract: Objective: To investigate the influence of nitric oxide(NO) and endothelin(ET)levels on liver function and portal hyperdynamics in patients with liver cirrhosis.Methods: The plasma levels of NO and ET of 51 cirrhotic patientswho were divided into group A(n=19),B(n=21) and C(n=11) according to the liver function and 31 normal controls were measured by Griess and radioimmunoassay,respectively.Color Doppler ultrasonography was used to measure the portal hypernamics(including portal venous and splenic venous blood flow) and automatic biochemistry analyzer was used to measure the liver function.Results: The NO and ET level in the plasma of the cirrhotic patients(including Child-Pugh A,B and C)was significantly higher than that of the controls(P<0.01).The NO and ET level in the plasma of the cirrhotic patients increased with the degeneration of the liver function and the difference was obvious between different grades(P<0.01).The ratio of NO/ET in the plasma of the cirrhotic patients(including Child-Pugh A,B and C)was significantly higher than that of the controls(P<0.05).The difference of NO/ET levels was significant between group A and group C(P<0.01),but the difference was not obvious between group B and group C(P>0.05).The plasma level of portal venous and splenic venous blood flow(PVBF and SVBF) was significantly higher in the cirrhotic patients than that in the controls(P<0.01).The increase was more obvious in group C.The difference was significant between group C and group A(P<0.01)but there was no difference between group C and group A.The plasma of NO and ET had a positive correlation with portal venous and splenic venous blood flow(PVBF and SVBF) in the cirrhotic patients,and it had a positive correlation with PVBF and SVBF in the controls.The plasma levels of NO and ET were significantly higher in ascites patients than those in the controls(P<0.01)and the no ascites patients (P<0.05).Conclusions: The serum levels of NO and ET are of great value in the evaluation of the liver function and the plasma levels of NO and ET may play an important role in the pathogenesis and promotion of portal hyperdynamics in patients with cirrhosis.

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