经颈静脉肝内门体分流术对肝硬化门脉高压症患者代谢的影响  

Effect of transjugular intrahepatic portosystemic shunt surgery on metabolism of patients with cirrhosis and portal hypertension

作　　者：金瑞放[1] 陈仁聘 林秀清[1] 陈周峰[1] 杨丹红[2] 

机构地区：[1]温州医科大学附属第一医院消化内一科,浙江温州325000 [2]浙江省人民医院内科,浙江杭州310014

出　　处：《中华全科医学》2016年第11期1820-1822,共3页Chinese Journal of General Practice

基　　金：2014浙江省医药卫生科技计划项目(2014KYA022)

摘　　要：目的对肝硬化门脉高压患者经颈静脉肝内门体分流术(TIPS)手术前后体质测量指标、糖代谢和肝肾功能变化情况进行研究,探讨TIPS术对肝硬化门脉高压症患者代谢的影响。方法选择2014年11月—2015年10月温州医科大学附属第一医院乙型肝炎肝硬化门脉高压性TIPS手术治疗患者56例作为研究对象,比较肝硬化门脉高压患者TIPS手术前后体质测量指标、糖代谢和肝肾功能变化情况。结果肝硬化门脉高压患者TIPS手术后1个月及6个月时的体重高于术前和术后7 d(P<0.05);肝硬化门脉高压患者TIPS术后7 d、1个月及6个月时干重高于术前(P<0.05)。肝硬化门脉高压患者TIPS术后7 d、术后1个月和术后6个月空腹胰岛素水平明显低于术前(P<0.05)。肝硬化门脉高压患者TIPS手术后7 d谷丙转氨酶和谷草转氨酶高于手术前(P<0.05),术后1个月和术后6个月谷丙转氨酶和谷草转氨酶均低于手术前(P<0.05),术后1个月和术后6个月谷丙转氨酶和谷草转氨酶低于术后7 d(P<0.05)。术后7 d白蛋白和术前比较差异无统计学意义(P>0.05),术后1个月和术后6个月白蛋白高于术前(P<0.05)。肝硬化门脉高压患者TIPS术后7 d、术后1个月和术后6个月尿素低于术前(P<0.05)。结论 TIPS术治疗门脉高压症肝硬化能够增加患者体重和干重,改善肝功能,改善胰岛素抵抗和尿素代谢。Objective To study the change of body mass index, glucose metabolism, and liver and kidney function in pa- tients with cirrhosis and portal hypertension after transjugular intrahepatic portosystemic shunt （TIPS）, and evaluate the effect of TIPS surgery. Methods A total of 56 patients with cirrhosis and portal hypertension undergoing TIPS surgical treatment in our hospital between November,2014 and October,2015 were enrolled into this study. The body mass index, glucose metabolism and liver and kidney function change before and after the surgery were compared. Results The weight at postoperative 1 month and 6 months were higher than preoperative and postoperative 7 days （P 〈 0.05 ） ;the dry weight at postoperative 7 days, 1 month and 6 months were higher than that before surgery（ P 〈 0.05 ）. The fasting insulin levels at postoperative 7 days, 1 month and 6 months were significantly lower than preoperative （ P 〈 0.05 ）. The alanine aminotransferase and aspartate aminotransferase at postoperative 7 days were higher than before the surgery （ P 〈 0.05 ）, the alanine aminotransferase and aspartate aminotransferase levels at postoperative 1 month and 6 months were lower than that before surgery （ P 〈 0. 05 ） , the alanine aminotransferase and aspartate aminotransferase levels at postoperative 1 month and 6 months were less than postoperative 7 days （ P 〈 0.05 ）, the albumin level at postoperative 7 days was no significant difference with preoperative, the albumin level at postoperative 1 month and 6 months were higher than that be- fore the surgery（P 〈0.05 ）. The urea level at postoperative 7days, 1 month and 6 months were lower than preoperative （ P 〈 0. 05 ）. Conclusion TIPS in patients with cirrhosis and portal hypertension can increase the weight and dry weight, and improve liver function, insulin resistance and urea metabolism.

关 键 词：肝硬化 TIPS 代谢 门脉高压症 

分 类 号：R657.31[医药卫生—外科学] R657.34[医药卫生—临床医学]