肝硬变门静脉高压症患者血浆内皮素水平、内毒素血症的临床研究  

A clinical study on plasma endothelin and endotoxemia in cirrhotic patients with portal hypertension

作　　者：柳枫 冷希圣[2] 朱继业[2] 冯洪强[2] 李澍[2] 杜如昱[2] 

机构地区：[1]哈尔滨医科大学第五临床医学院省电力医院普通外科 [2]北京医科大学人民医院普外科,100044

出　　处：《中华普通外科杂志》2000年第4期213-215,共3页Chinese Journal of General Surgery

摘　　要：目的　肝硬变患者血浆内皮素含量究竟升高还是降低 ,学术界还有争论 ,鉴于内皮素的强大血管活性作用 ,因此有必要进一步探讨。方法　我们用放射免疫法测定了 12 1例肝硬变患者和5 0例年龄、性别相称的对照者血浆内皮素水平 ,并探讨了与合并腹水者内毒素血症的关系。结果　肝硬变患者血浆内皮素水平比对照组明显增高〔股动脉 :(82± 2 0 )pg/ml,(30± 8)pg/ml,P <0 0 1;股静脉 :(90± 2 3)pg/ml,(34± 8)pg/ml,P <0 0 1;贵要静脉 :(87± 2 3)pg/ml,(33± 8)pg/ml,P <0 0 1〕。此外 ,合并腹水的肝硬变患者股静脉血内皮素含量比无腹水患者增高明显〔(10 6± 17)pg/ml,(90±2 3)pg/ml,P <0 0 1)。股静脉血浆内皮素含量与内毒素血症的严重程度呈正相关 (rs=0 6 1,P =0 0 34 )。结论　肝硬变门静脉高压症患者血浆内皮素水平的增高可能对肝硬变患者门静脉血管阻力的增加有重要影响 ,内毒素是内皮素合成和释放的强烈刺激因子。Objective Plasma endothelin concentration in cirrhotics has been reported to be increased in some studies and normal or decreased by others.In this study we provide a further insight into these issues. Methods We meassured the plasma endothelin concentrations using radioimmunoassay in 121 patients with cirrhosis and compared these values to 50 age and sex matched control subjects, and evaluated systemic endotoxemia in relation to ascites.Results Compared with normal controls,femoral venous plasma endothelin levels significantly increased in cirrhotic patients (90±23)pg/ml v.s. (34±8)pg/ml, P <0 01, and that of cirrhotics with ascites was higher than those without 〔(106±17)pg/ml v.s. (90±23)pg/ml, P <0 01〕. Moreover, plasma endothelin levels increased in proportion to the severity of endotoxemia ( r s=0 61, P =0 034).Conclusions The elevated endothelin level has a significant influence on the portal vascular resistance of cirrhotic liver in vivo and has an important role in the pathogenesis of portal hypertension. Endotoxin is a strong stimulator for the synthesis and release of endothelin.

关 键 词：内皮素 内毒素血症 肝硬化 门脉高压症 

分 类 号：R657.34[医药卫生—外科学]