脾切除贲周血管离断术对肝硬化患者术后血清MMP-1、TIMP-1及肝纤维化指标的影响  

The effects of splenectomy plus esophagogastric devascularization on serum MMP-1,TIMP-1 and cirrhotic serum markers of liver cirrhosis patients

作　　者：王建春[1] 陈坚[1] 刘绪舜[1] 

机构地区：[1]安徽医科大学解放军81临床学院普外科

出　　处：《临床外科杂志》2015年第3期200-202,共3页Journal of Clinical Surgery

基　　金：2012年度南京区医学科技创新课题(编号:12MA039)

摘　　要：目的：探讨脾切除贲周血管离断术对慢性乙型肝炎肝硬化门静脉高压症患者肝纤维化指标及肝硬化病程的影响和可能机制。方法选择20例HBsAg（＋）、HBV-DNA（-）门静脉高压症患者，其中肝功能Child-Pugh A级14例，Child-Pugh B级6例。分别于脾切除贲周血管离断术前后，采用酶联免疫吸附试验（ELISA）法测定血清基质金属蛋白酶-1（MMP-1）和基质金属蛋白酶组织抑制因子-1（TIMP-1）；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）血清TIMP-1及肝纤4项指标较术前明显下降（p〈0.05），MMP-1较术前缓慢升高（ p〈0.05）。（2）TIMP-1与肝纤四项指标的变化成正相关关系（ r=0.458∽0.783，p 〈0.01/0.05），MMP-1与肝纤4项指标的变化呈负相关关系（ r =-0.545∽-0.873，p〈0.01/0.05）。结论脾切除贲周血管离断术可使肝纤维化血清学指标和TIMP-1含量下降、MMP-1含量缓慢升高，有利于减缓肝硬化患者的病情进展。Objective To investigate the effects and their potential mechanisms of splenectomy plus esophagogastric devascularization on non-invasive indexes of liver fibrosis and the cirrhosis progress in portal hypertensive patients with HBV-related cirrhosis. Methods Twenty consecutive portal hypertensive patients with positive HBsAg,negative HBV-DNA and Child-Pugh A（n=14）or B（n=6）were collected in this study. ELISA method was used to test the level of serum MMP-1 and TIMP-1;electrochemilumines-cence was used to measure hyaluronic acid（ HA）,N-terminal type Ⅲ procollagen peptide（ PC-Ⅲ）,lami-nin（LN）and collagen typeⅣ（C-IV）. Results The serum TIMP-1,HA,PCⅢ,LN,and C-Ⅳwere signifi-cantly lower than the preoperative levels（p〈0. 05）,and MMP-1 slowly increased compared with the pre-operative levels（p〈0. 05）. The changes between TIMP-1 and HA,PC-Ⅲ,LN,or C-Ⅳ were positively correlated（r=0. 458∽0. 783,p〈0. 01/0. 05）. The changes between MMP-1 and HA,PC-Ⅲ,LN,or C-Ⅳ were negatively correlated（r= -0. 545∽ -0. 873,p〈0. 01/0. 05）. Conclusion Splenectomy plus esophagogastric devascularization can decrease non-invasive hepatic fibrosis serum markers and cytokines （TIMP-1）,conducive to slowing down the disease progression in patients with cirrhosis.

关 键 词：脾切除贲周血管离断术 肝硬化 MMP-1 TIMP-1 

分 类 号：R657.3[医药卫生—外科学]