TIPS联合PSE对肝硬化患者外周血细胞水平、免疫球蛋白、血氨及安全性的影响  

Effects of TIPS combined with PSE on peripheral blood cell levels,immunoglobulin,blood ammonia and safety in patients with liver cirrhosis

作　　者：金瑞放[1] 陈周峰[1] 薛海波[1] 陈蒙君 JIN Ruifang;CHEN Zhoufeng;XUE Haibo(Department of Gastroenterology,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

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

出　　处：《全科医学临床与教育》2019年第5期425-427,431,共4页Clinical Education of General Practice

基　　金：浙江省温州市科技局公益类项目(Y20150162)

摘　　要：目的探究经颈静脉肝内门体分流术(TIPS)联合部分性脾栓塞术(PSE)对肝硬化伴脾亢患者外周血细胞水平、免疫球蛋白、血氨及安全性的影响。方法选择74例肝硬化患者,依据治疗方法分为观察组(n=37)和对照组(n=37),对照组仅行TIPS治疗,观察组行TIPS与PSE联合治疗。分析比较两组外周血细胞水平、免疫球蛋白、血氨及不良反应的变化。结果术后7 d及30 d,观察组外周血细胞血小板(PLT)、白细胞(WBC)水平明显高于术前及对照组(t分别=6.25、4.25、6.30、4.63、7.34、4.71、6.25、4.69,P均<0.05);术后30 d,观察组IgA、IgG及IgM水平明显高于术前及对照组(t分别=3.78、3.14、3.94、3.23、3.84、3.20,P均<0.05)。术后30 d,两组血氨水平明显高于术前(t分别=6.42、5.07,P均<0.05),两组间血氨水平比较,差异无统计学意义(t=0.90,P>0.05)。两组轻微并发症及严重并发症的比较,差异均无统计学意义(χ~2分别=0.35、0.56,P均>0.05)。结论 TIPS与PSE联合治疗可改善肝硬化伴脾亢患者外周血细胞水平,减轻患者免疫抑制作用,不增加患者术后并发症风险。Objective To explore the effects of transjugular intrahepatic portosystemic shunt(TIPS)combined with partial splenic embolization(PSE)on peripheral blood cell levels,immunoglobulin,blood ammonia and safety in patients with liver cirrhosis with hypersplenism. Methods A total of 74 patients with liver cirrhosis were divided into observation group(37 cases)and control group(37 cases)according to the different treatment methods.The control group was treated with TIPS only,and the observation group was treated with TIPS combined with PSE.The changes of peripheral blood cell level,immunoglobulin,blood ammonia and adverse reactions were compared between the two groups. Results Seven days and thirty days after operation,the levels of PLT,WBC in the observation group were significantly higher than those before operative and the control group(t=6.25,4.25,6.30,4.63,7.34,4.71,6.25,4.69,P<0.05).Thirty days after surgery,the levels of IgA,IgG and IgM in the observation group were significantly higher than those before surgery and the control group(t=3.78,3.14,3.94,3.23,3.84,3.20,P<0.05).Thirty days after surgery,the blood ammonia levels of the two groups were significantly higher than before surgery(t=6.42,5.07,P<0.05),but there was no statistically significant difference between the two groups(t=0.90,P>0.05).There were no significant differences in minor and serious complications between the two groups(χ^2=0.35,0.56,P>0.05). Conclusions The combined therapy of TIPS and PSE can improve the peripheral blood cell level of cirrhosis patients with hypersplenism,alleviate the immunosuppressive effect,and do not increase the risk of postoperative complications.

关 键 词：经颈静脉肝内门体分流术 部分性脾栓塞术 肝硬化 外周血细胞 免疫 血氨 安全性 

分 类 号：R575.2[医药卫生—消化系统]