生长抑素十四肽和八肽对门脉高压症患者肝内门体分流术后门静脉血流动力学的影响  

Effects of Somatostatin-14 and-8 on portal hemodynamics in patients with portal hypertension after intrahepatic portosystemic shunt

作　　者：杨建芬[1] 吴性江[1] 黎介寿[1] 曹建民[2] 韩建明[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002 [2]南京军区南京总医院医学影像科,江苏南京210002

出　　处：《医学研究生学报》2007年第11期1186-1188,共3页Journal of Medical Postgraduates

基　　金：江苏省自然科学基金创新人才项目(批准号:BK2005432);南京军区南京总医院科研基金资助项目(批准号:2005050)

摘　　要：目的:研究生长抑素十四肽和八肽对门脉高压症患者门静脉血流动力学的影响和外周静脉血中胰岛素样生长因子(IGF-1)、血管内皮素(ET-1)、胰高血糖素(GLU)、一氧化氮(NO)浓度变化。方法:采用两交叉设计对14例门脉高压症经颈内静脉肝内门体分流术(TIPS)后患者经颈内静脉留置于门静脉内支架下方的导管,直接测静脉压,动态观察门静脉血流动力学改变,同时检测IGF-1、ET-1、GLU、NO血浆浓度。生长抑素十四肽(6 mg/d)、生长抑素八肽(0.6mg/d)分别于TIPS术后24 h采用微量泵持续24 h经周围静脉输注。用药前及用药后8、24 h进行检测。结果:生长抑素十四肽和八肽用药前后门静脉压力最大差值分别为(9.4±1.0)cmH2O和(5.0±1.0)cmH2O,两者用药前后比较有非常显著性差异(P<0.01),生长抑素十四肽与八肽两者比较有非常显著性差异(P<0.01)。IGF-1、GLU用药前后比较有显著性差异(P<0.05)。NO、ET-1用药前后比较无显著性差异(P>0.05)。结论:生长抑素十四肽(6mg/d)、生长抑素八肽(0.6mg/d)均有降低门静脉压力的作用,但生长抑素十四肽的降压作用更为显著。两者用药后显著降低血中IGF-1、GLU浓度。其作用机制可能是通过降低血中IGF-1、GLU等激素的分泌和释放,降低肝的代谢,减少肝血流量,从而降低门静脉压力。Objective：To study the effects of Somatostatin-14 and -8 on portal hemodynamics and plasma levels of the insulin-like growth factor （ IGF-1 ）, nitric oxide （ NO）, endothelin-1 （ ET-1 ） and glucagon （GLU） in patients with portal hypertension after transjugular intrahepatic portosystemic shunt （TIPS）. Methods： Fourteen portal hypertension patients underwent TIPS, their portal pressures directly measured by the intravenous catheter placed in the portal vein, the hemodynamic changes observed and the plasma levels of IGF-1, NO, ET-1 and GLU determined before and 8 and 24 hours after the infusion of Somatostatin-14 or -8 according to a cross-over design. Results ：The average decrease in portal pressure after the intravenous infusion of Somatostatin-14 and -8 was （9.4 ±1.0 ） cmH20 and （5.0 ± 1.0 ） cmH2O, respectively （P 〈 0.01 ）, with significant differences before and after the infusion as well as between the Somatostatin-14 and -8 groups （ P 〈 0.01 ）. Significant reduction was observed in GLU and IGF-1 （P 〈 0.05 ）, but not in NO and ET-1 （ P 〉 0.05 ） 8 and 24 hours after the infusion. Conclusion ：Both Somatostatin-14 and -8 can significantly reduce portal pressure, although the former is more potent than the latter. The underlying mechanism may involve their inhibition of the secretion of GLU, IGF-1 and other hormones as well as their reduction of hepatic metabolism and portal inflow.

关 键 词：门脉高压症 生长抑素 血流动力学 

分 类 号：R543.6[医药卫生—心血管疾病]