经颈静脉肝内门体分流术对肝硬化患者肝脏功能与炎症介质影响

目的研究肝硬化患者经颈静脉肝内门体分流(TIPS)术后的肝功能及炎症介质的变化并探讨二者间的相互关系。方法纳入2016年4月至2017年4月华西医院消化内科72例行TIPS术肝硬化患者术前及术后一周、一月、三月和半年肝功能及血炎症介质水平,分析二者间的关系。结果72例肝硬化患者TIPS术后肝功能指标较术前发生一过性恶化(P<0.05),但术后半年肝功能逐渐恢复到术前水平。此外,血炎症介质与肝功能变化呈显著线性相关性,其中肿瘤坏死因子-α(TNF-α)与总胆红素(TB)、直接胆红素(DB)、谷丙转氨酶(ALT)和谷草转氨酶(AST)呈直线正相关(P<0.05);可溶性白介素受体-2(slL-2R)与TB、DB和AST呈直线正相关(P<0.05);白介素-6(IL-6)与TB和DB呈直线正相关(P<0.05);白介素-8(IL-8)与TB、DB和AST呈直线正相关(P<0.05);而TNF-α、slL-2R、IL-6、IL-8与白蛋白呈直线负相关(P<0.05)。结论肝硬化患者TIPS术后短期内出现一过性肝功能受损,中远期肝功能逐渐恢复,炎性介质与肝功能变化密切相关。

The influence of transjugular intrahepatic portosystemic shunt on the liver function and the inflammatory factor in patients with liver cirrhosis

Objective To study the changes of the liver functions and inflammatory factor after transjugular intrahepatic portosystemic shunt(TIPS)and the relations between the liver function and the inflammatory factor.Methods During April 2016 to April 2017,72 patients of liver cirrhosis who received transjugular intrahepatic portosystemic shunt(TIPS)in department of gastroenterology West China Hospital Sichuan University were included in this study.The data of the liver function test and the blood inflammatory factor level before operation and 1 week,1 month,3 months and 6 months after operation were obtained.In addition of the relationship between the liver function and the inflammatory factor was analyzed.Results 72 patients with liver cirrhosis who received TIPS experienced transient deterioration of the liver function(P<0.05).However,the liver function gradually recovered from the 30 days to 180 days after TIPS.In addition,significant linear correlation lay between the blood inflammatory factor and the liver function.Detailedly,linear positive correlations lay between tumor necrosis factor-α(TNF-α)and total bilirubin(TB),direct bilirubin(DB),alanine aminotransferase(ALT),and aspartate aminotransferase(AST),respectively(P<0.05);linear positive correlations lay between soluble interleukin-2 receptor(sIL-2R)and TB,DB,and AST,respectively(P<0.05);linear positive correlations also lay between interleukin-6(IL-6)and TB,and DB,respectively(P<0.05);linear positive correlations also lay between interleukin-8(IL-8)and TB,DB,and AST(P<0.05).Still,linear negative correlations were demonstrated between albumin and TNF-α,sIL-2R,IL-6,and IL-8,resoectively(P<0.05).Conclusion Patients with liver cirrhosis who received TIPS experience transient liver dysfunction,but have no significant affect on the long-term liver function.Besides that,close relationship is existed between the inflammatory factors and the liver function.