加味瓜蒌散对肝硬化门静脉高压症患者胃肠激素、肝纤维化指标和血流动力学的影响

目的:观察加味瓜蒌散对肝硬化门静脉高压症患者胃肠激素、肝纤维化指标和血流动力学的影响.方法:选择符合2000年9月西安全国传染病与寄生虫病学术会议<肝硬化诊断标准>同时符合中医血瘀阻络证型肝硬化门脉高压症患者40例,随机分治疗组和对照组.两组患者均常规接受护肝、降酶等对症治疗,治疗组患者加服加味瓜蒌散,对照组患者加服心得安(通用名普萘洛尔).治疗前后清晨空腹取血放射免疫法测胃肠激素胃动素(MTL)、胃泌素(GAS)、胰高血糖素(GLU)、脑肠肽(SS),肝纤维化指标透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C-Ⅳ)、层粘连蛋白(LN),并进行血流动力学检查.结果:治疗组治疗后GAS、MTL水平明显下降(P＜0.01或P＜0.05),HA、PCⅢ、C-Ⅳ、LN下降(P＜0.01或P＜0.05),门静脉内径、血流量与用药前比较差异有显著性意义(P＜0.05),血流速度治疗前后与对照组比较差异无显著性意义(P＞0.05).结论:加味瓜蒌散能够有效调节肝硬化门静脉高压症患者胃肠激素、血流动力学,降低纤维化指标,延缓门脉高压的形成,减轻门脉高压性胃病的程度,减少食管胃底静脉曲张破裂出血的机会及风险,疗效优于心得安,是防治肝硬化门脉高压症的有效方剂.     

加味瓜蒌散对门静脉高压症大鼠门静脉压力与肝纤维化指标的影响

目的:观察加味瓜蒌散对门脉高压大鼠门静脉压力、肝纤维化指标的影响。方法:采用M ed lab-Ug4Cs生物信号采集处理系统、放免法,检测正常组、模型组、心得安对照组、加味瓜蒌散治疗组大鼠门静脉压力、肝纤维化指标。结果:模型组大鼠门静脉压力较正常组明显升高(P<0.01),加味瓜蒌散各剂量组、心得安对照组大鼠门脉压力较模型组明显下降(P<0.01),加味瓜蒌散各剂量组大鼠门脉压力与心得安治疗组比较,差异无显著性意义(P>0.05)。加味瓜蒌散各剂量组大鼠Ⅳ-C、PCⅢ、HA、LN与模型组比较均明显下降(P<0.01或P<0.05);而心得安组大鼠Ⅳ-C、PCⅢ、LN与模型组比较,差异无显著性意义(P>0.05),而HA明显升高(P<0.05)。结论:加味瓜蒌散能有效降低门静脉压力,在改善肝纤维化指标方面优于心得安。其作用机制可能与其良好的抗肝纤维化、阻止肝硬化形成、降低门脉压力、改善肝功能的作用有关。     

长效奥曲肽对大鼠肝纤维化门静脉高压形成的影响

目的:探讨长效奥曲肽对四氯化碳(CC14)诱发大鼠肝纤维化门静脉高压的影响和机制.方法:SD大鼠40只,随机分为正常对照组(n=8)、肝纤维化门脉高压组(n=16)和长效奥曲肽组(n=16).以.2400 mL/I,CC14 sc(3 mL/kg)建立大鼠肝纤维化门脉高压症模型,长效奥曲肽组同时给以长效奥曲肽(0.8 mg/kg),每4 wk肌肉注射1次.8 wk后检测门静脉压力、肝脏组织形态学改变、血浆胰高血糖素和内皮素等.结果:长效奥曲肽组门静脉压、胰高血糖素和内皮素较肝纤维化门脉高压组显著降低(t=2.5,P<0.05;t=2.088,P<0.05;t=2.102,P<0.05),但仍高于正常对照组(t=5.152,P<0.01;t=2.896,P<0.01;t=2.770.P<0.05).正常对照组大鼠肝脏大体形态和组织学无异常改变:肝纤维化门脉高压组及长效奥曲肽组大鼠肝脏组织形态学表现为肝纤维化改变.但后者的病理损害指标显著轻于前者(P<0.05).结论:长效奥曲肽组大鼠门静脉压力显著低于肝纤维化门脉高压组,其机制可能与肝脏组织损害减轻、血浆胰高血糖素和内皮素降低等有关.     

丹参益肝自乳化微乳抗大鼠门静脉高压的作用

目的研究丹参益肝自乳化微乳对大鼠肝硬化引起的门静脉高压的治疗作用。方法建立大鼠肝硬化门静脉高压模型,健康大鼠作为空白对照组,造模成功的大鼠随机分为4组,分别为门静脉高压模型对照组、盐酸普萘洛尔(心得安)组、丹参自乳化微乳高剂量组、丹参自乳化微乳低剂量组,分别测定给药前、后门静脉压力及给药后肝硬化指标、肝功能、抗氧化指标的变化。结果丹参自乳化微乳能显著降低大鼠门静脉压力(P0.01),显著改善肝硬化指标(P0.01),改善肝功能,显著降低体内丙二醛(MDA)含量(P0.05),超氧化物歧化酶(SOD)显著升高(P0.01),同时可使大鼠体内羟脯氨酸(HyP)升高(P0.05),一氧化氮(NO)、一氧化氮合酶(NOS)含量显著升高(P0.01)。结论丹参益肝自乳化微乳可改善肝脏微循环,改善肝功能,从而降低门静脉高压。     

糖尿病大鼠血浆和组织中胃泌素、胃动素、胰高糖素的变化及意义

目的探讨糖尿病大鼠血浆和胃组织中胃肠激素的变化.方法选择雄性SD大鼠26只,用四氧嘧啶建立糖尿病模型,4周后取血浆和胃窦组织中测定各鼠胃泌素、胃动素、胰高糖素水平.结果与正常组比,糖尿病大鼠血浆中胃泌素和胃动素水平低下(P＜0.05);胰高糖素水平增高(P＜0.05);胃组织中胃动素水平低下(P＜0.05).结论糖尿病大鼠血浆中胃泌素、胃动素水平低下,胰高糖素水平增高,胃组织中胃动素水平低下.     

氯沙坦对肝硬化门静脉高压症大鼠肝静脉压力梯度的影响

目的:探讨氯沙坦对肝静脉压力梯度(HVPG)的作用及其机制.方法:采用复合因素法制作大鼠肝硬化门静脉高压症(PHT)模型,49只雄性Wistar大鼠随机分为5组:正常对照组、模型对照组、3个治疗组(分别给予10mg·kg-1·d-1、 5mg·kg-1·d-1、2.5mg·kg-1·d-1 3种剂量氯沙坦).治疗21天结束后,进行各项指标检测.结果:①与正常对照组比较,模型对照组肝静脉楔入压(WHVP)、HVPG显著升高(P＜0.05),游离肝静脉压(FHVP)、平均动脉压(MAP)和心率(HR)无明显变化;内皮型-氧化氮合酶(eNOS)的表达减少,肝匀浆氧化氮(NO)水平无明显变化但内皮素(ET)水平升高(P＜0.05);②治疗21天结束后,与模型对照组比较,各治疗组HVPG均有显著下降(P＜0.05),3组之间比较差别无统计学意义.而高剂量组导致了MAP的显著下降(P＜0.05);③与模型对照组比较,各治疗组eNOS的表达显著升高(P＜0.05),肝内NO含量增加而ET水平降低(P＜0.05),各治疗组之间比较差别无统计学意义.结论:氯沙坦能有效地降低肝硬化大鼠的HVPG,中、低剂量具有与高剂量类似的治疗效果,且对全身血流动力学影响小.     

枳实消痞颗粒剂对糖尿病大鼠胃肠激素的影响

目的:探讨枳实消痞颗粒剂对糖尿病大鼠胃肠激素的影响.方法:选择雄性SD大鼠60只,用四氧嘧啶建立糖尿病模型,用枳实消痞颗粒剂每天灌服治疗组大鼠,连续4周,实验结束取血浆测定各鼠胃泌素(GAS)、胃动素(MOT)、胰高糖素及P物质(SP).结果:糖尿病组大鼠GAS和MOT水平低下,与正常组比较均P＜0.05;胰高糖素水平增高,与正常组比较均P＜0.05;SP在各组中表达差异无统计学意义;枳实消痞颗粒剂能提高MOT水平,与模型组比较P＜0.05.结论:糖尿病大鼠GAS、MOT水平低下,胰高糖素水平增高;枳实消痞颗粒剂能提高糖尿病大鼠的MOT水平.     

非洛地平缓释片与心得安联用对肝硬化患者门脉血流动力学的影响

目的探讨非洛地平缓释片和心得安联合应用对肝硬化门脉高压的治疗作用.方法69例肝硬化门脉高压患者随机分为非洛地平组、心得安组和联合用药组,以多普勒超声检测三组患者治疗前、后门脉血流动力学的变化.结果治疗4周后,联用组门脉流速、流量及脾静脉内径、流速、流量均较治疗前有明显减少.门脉流速、流量、脾静脉血流量的减少联用组较其他两组明显(P＜0.05),此外脾静脉内径、血流速度联用组还较心得安组明显减少(P＜0.05).三组患者治疗后平均动脉压无显著下降.结论非洛地平缓释片和心得安联合应用较单一应用具有更好的降低肝硬化患者门脉压力的作用.     

门脉高压大鼠胰岛功能障碍的研究

目的探讨门脉高压时胰岛功能的变化。方法应用放免法检测肝硬化门脉６高压、肝前性门脉高压及正常大鼠循环血液中胰岛素及胰高血糖素水平。采用非酶法分离并纯化以上三组大鼠胰岛,检测其体外生物学活性。结果二种门脉高压模型鼠循环血液中胰岛素及胰高血糖素水平均明显高于正常对照组（Ｐ＜０．０１）;其分离纯化的胰岛经体外培养４８小时及在含糖基质中孵育２小时后,胰岛素释放量明显低于正常对照组,胰高血糖素释放量明显高于正常对照组（Ｐ＜０．０１）。结论门脉高压时：①循环血液中胰岛素及胰高血糖素水平增加;②胰岛α细胞分泌增加可能有助于门脉高压高胰高血糖素血症的发生;③循环血液中胰岛素水平增加,但胰岛β细胞功能明显低于正常。     

泽泻对肝硬化门脉高压大鼠血流动力学的影响

目的研究泽泻对肝硬化门脉高压血流动力学的影响,寻求治疗肝硬化门脉高压的理想药物.方法采用40%四氯化碳诱导大鼠肝硬化门脉高压模型.对肝硬化门脉高压大鼠进行泽泻灌胃治疗(每日5 g/kg,疗程1个月),然后测定尿量、门静脉压力、肠系膜上动脉血流量和血管阻力、平均动脉压等血流动力学指标.应用放射免疫法测定泽泻治疗前后血浆肾素和醛固酮水平.以中药丹参作为治疗对照组.结果泽泻具有明显利尿作用,治疗后可使肝硬化大鼠尿量明显增加[(12.33士5.55)(31.05±24.91)ml/24 h,P＜O.01)],并能够显著减少肠系膜上动脉血流量[(34.39士12.20)(21.96士4.16)ml/(min·kg),P＜0.01)]和门静脉压力[(1.90士O.21)(1.44士O.33)kPa,P＜O.05)].泽泻治疗前后血浆肾素、醛固酮水平无明显改变.结论泽泻具有明显降低肝硬化门脉压力的作用,可能是通过利尿和减少肠系膜上动脉血流量发挥作用.泽泻可作为治疗肝硬化门脉高压的有效药物.     

门静脉高压患者门静脉压力与血流动力学的相关性研究

目的 探讨门静脉高压患者门静脉血流动力学的变化特点及其与门静脉压力的相互关系。方法 采用彩色多普勒超声对４１例肝硬化门静脉高压患者（Ｃｈｉｌｄ Ａ、Ｂ级３１例、Ｃ级１０例）于手术前检测门静脉（ＰＶ）、脾静脉（ＳＶ）和肠系膜上静脉（ＳＭＶ）的内径和血流速度，再计算出相关的面积和血流量；于手术时对３１例ＣｈｉｌｄＡ十Ｂ级患者直接测量门静脉压力。３２例健康人和２６例慢性乙型肝炎患者（慢肝组）作为对照。结累 门静脉高压两组患者ＰＶ、ＳＶ和ＳＭＶ内径（ｃｍ）分别为１．５１和１．５２、１．３２和１．３４及１．１５和１．１５较慢肝组和正常组明显增宽，ｒ分别为１．３１和１．１６、０．９６和０．７９及０．９１和０．８２（Ｐ＜０．０１）；血流速度较正常组和慢肝组明显减慢（Ｐ＜０．０１）；门静脉高压Ｃ级组门静脉血流速度（ｃｍ／ｓ）为４．６５较门静脉高压Ａ十Ｂ级组（６．４２）明显减慢（Ｐ＜０．０１），而两组 ＳＶ和 ＳＭＶ的血流速度则差异无显著意义（Ｐ＞０．０５）；门静脉高压 Ａ＋Ｂ级组三条静脉的血流量明显大于正常组和慢肝组（Ｐ＜０．０１或Ｐ＜０．０５）；门静脉高压Ｃ级组门静脉血流量明显小于Ａ十Ｂ级组（Ｐ＜０．０１）；而ＳＶ和ＳＭＶ的血流     

胰源性与特发性门脉高压症的临床特点分析

目的探讨PPH与IPH的临床特点,加深对二者的认识,提高临床医师的诊治水平。方法对18例PPH与36例IPH患者的临床资料作一回顾分析。结果二者的肝脏形态、功能正常,病毒学指标阴性,超声检查脾静脉迂曲扩张,脾肿大;PPH患者超声检查门静脉正常,胰腺可见炎症、肿瘤、囊肿等表现;IPH患者门静脉及肠系膜上静脉迂曲扩张,但胰腺方面无异常。IPH患者汇管区纤维组织增生和炎性细胞浸润但无肝硬化改变而PPH患者肝脏组织学正常。结论临床中发现肝脏形态、功能正常,病毒学指标阴性,以门脉高压为主要表现而无肝硬化改变的患者,应考虑IPH与PPH的可能。进一步行超声检查门脉系统及胰腺情况,可进一步区分二者。     

Extrahepatic aneurysm of the portal venous system and portal hypertension

Portal venous aneurysm (PVA) is a rare condition characterized by dilatation of the portal venous system. PVA manifestation of symptoms is varied and depends on the aneurysm size, location and related-complications, such as thrombosis. While the majority of reported cases of PVA are attributed to portal hypertension, very little is known about the condition’s pathophysiology and clinical management remains a challenge. Here, we describe a 67-year-old woman who presented with complaint of dyspepsia and without a significant medical history, for whom PVA was incidentally diagnosed. The initial upper abdominal ultrasound revealed marked dilatation of the main portal vein, and subsequent contrast-enhanced computed tomography with angiography revealed a large aneurysm arising from the extrahepatic troncus portion of the portal vein, as well as gastroesophageal varices. A conservative approach using beta-blocker therapy was chosen. The patient was followed-up for 60 mo, during which time the asymptomatic status was unaltered and the PVA remained stable.     

EUS-guided portal vein catheterization: a promising novel approach for portal angiography and portal vein pressure measurements

BACKGROUND: Portal vein (PV) pressure measurements can provide valuable information for the management of patients with liver disease and portal hypertension. OBJECTIVE: To evaluate the feasibility and the safety of EUS-guided PV catheterization and pressure measurements in a porcine model. SETTING: Acute and survival experiments on five 50-kg pigs. DESIGN AND INTERVENTIONS: Intrahepatic PV was punctured under EUS guidance by using a 19-gauge FNA needle. A 0.035-inch guidewire was advanced through the needle into the PV. The needle was withdrawn. A 5.5F ERCP catheter was advanced over the guidewire into the PV and then connected to a pressure monitor. Continuous PV measurements were obtained for an hour. Afterward, the catheter was removed, and the animals were observed for 30 minutes. Three animals were then immediately euthanized for a necropsy. The other two animals were observed for two weeks and then were euthanized. MAIN OUTCOME MEASUREMENTS: The ability to perform EUS-guided PV catheterization and pressure measurement without complications. RESULTS: PV catheterization, angiography, and pressure measurements were performed without any problems or complications. There were no changes in vital signs and hemodynamic parameters during PV catheterizations, angiography, pressure measurements, and catheter removal. Survival experiments did not demonstrate any change in animal condition, behavior, or eating habits after the procedure. A necropsy in all animals revealed no active bleeding, and no damage to the liver, other intra-abdominal organs, or blood vessels. LIMITATIONS: No validation of measured PV pressure was made. CONCLUSIONS: EUS-guided PV catheterization is feasible, safe, and can be used for portal angiography and pressure measurements.     

Laparoscopic cholecystectomy in patient with portal cavernoma and portal hypertension.

Successful laparoscopic cholecystectomy has been reported in patients with cirrhosis of liver with portal hypertension; the procedure has, however, not been reported in patients with portal vein thrombosis, portal cavernoma and portal hypertension. We report an 18-year-old man with portal hypertension due to portal vein thrombosis and portal cavernoma who had symptomatic gallstone disease and was successfully treated with laparoscopic cholecystectomy.