肝硬化门脉高压患者血流动力学及血管活性物质与肝功能的相关性研究  

Correlational study of the hemodynamics and vasoactive substances of portal hypertension patients with their liver function

作　　者：王振常[1] 黄晶晶[1] 黄瑞华 吕建林[1] 潘哲[1] 

机构地区：[1]广西中医药大学第一附属医院,广西南宁530023 [2]广西防城港市中医院,广西防城港538021

出　　处：《右江医学》2013年第4期481-483,共3页Chinese Youjiang Medical Journal

基　　金：广西壮族自治区卫生厅重点课题(编号:重200935);广西壮族自治区教育厅重点课题(编号:200911MS119)

摘　　要：目的探讨门静脉血流动力学指标与肝功能Child-Pugh分级的关系。方法选择确诊为肝硬化门脉高压患者120例,依据肝功能Child-Pugh分级标准分为A级(44例)、B级(48例)、C级(28例)三组,应用彩色多普勒超声检测三组患者门静脉内径、血流速度并计算血流量;观察临床症状、生化指标[总胆红素(TBIL)、白蛋白(ALB)、凝血酶原时间(PT)]及血管活性物质[内皮素-1(ET-1)、一氧化氮(NO)、胰高血糖素(GLU)]的变化。结果门静脉内径比较:C级明显高于A级及B级,三组间差异有统计学意义(P<0.01);门静脉血流速度比较:C级与A级、B级比较差异有统计学意义(P<0.01),但A级与B级比较差异无统计学意义(P>0.05);门静脉血流量比较:C级明显高于A级及B级,三组间差异有统计学意义(P<0.01)。随着Child-Pugh分级由A→B→C递增,C级的ET-1、NO及GLU含量明显高于A级及B级,三组间差异具有统计学意义(P<0.01)。三个指标的含量与肝功能Child-Pugh分级呈正相关。结论门静脉系统血流状态可能在一定阶段受到某种稳定机制的调节,随着肝功能损害程度和血管活性物质代谢障碍的加重,这种稳定机制最终发生明显改变;同时门静脉血流动力学的改变、血管活性物质含量的增加也反映了肝功能损害程度。Objective To investigate the relation of the hemodynamic changes of portal vein and the Child-Pugh classification of liver function. Methods 120 patients diagnosed with portal hypertension were divided into Class A（44 cases） ,Class B（48 cases）,Class C（28 cases） according to the Child-Pugh classification of liver function. The portal vein diameter and blood flowvelocity of the patients were detected by color doppler ultrasound. The blood flow volume was also calculated. The changes of clinical symptoms, the biochemical index [-including total bilirubin（TBIL）, albumin （ALB） and prothrombintime （PT）] and the changes of vasoactive substances[including endothelin-1 （ET-1）, nitric oxide （NO） and glucagon （GLU）]were all observed. Results 1. Comparison in terms of portal vein diameter：Class C had significantly higher portal vein diameter than Class A and Class B, so the differences among the three groups were statistically significant（ P 〈0.01）. 2. Comparison in blood flowvelocity of portal vein： differences between Class C and Class A, Class C and Class B were statistically significant （ P 〈0.01）, but the difference between Class A and Class B had no statistical significance （ P ~0.05）. 3. Comparison in terms of portal venous flow：Class C had signifi- cantly higher portal venous flow than Class A and Class B,and differences among the three groups were statistically significant（（ P 〈0.01）. With the Child-Pugh classification gradually increasing from A to B to C,the ET-1 ,NO and GLU levels of Class C were obviously higher than those of Class A and Class B. So the differences among the three groups was statistically significant（ P 〈0.01）. The three indexes mentioned above were positively correlated with Child-Pugh classification of liver function. Conclusion The blood flow state of portal vein may be regulated by some stability mechanism in certain stage. With the exacerbation of liver function damage and the metabolic disorder of vasoactive substances

关 键 词：门静脉高压症 血管活性物质 血流动力学 肝功能Child—Pugh分级 

分 类 号：R657.34[医药卫生—外科学]