磁共振成像定量门静脉高压症血流动力学改变与门静脉压力相关性研究

目的采用电影相位对比磁共振成像（MRI）定量测量肝硬化门静脉血流,评价其与术中门静脉压力相关性。方法 34例肝硬化门静脉高压患者为肝硬化组,男21例,女13例;平均年龄48.6岁;采用电影相位对比MRI对34例门静脉高压症患者术前1周行门静脉血流定量测量,术中测量门静脉压力。对照组为性别比、年龄与肝硬化组匹配的健康志愿者19例。结果肝硬化组门静脉主干截面积与对照组比较均显示显著性增大（P〈0.05）,肝硬化组门静脉血流量为（21.71±12.42）cm3/s,与正常组比较明显增高（P〈0.05）,肝硬化组流速较正常对照组略减低,但差异无统计学意义（P〉0.05）。34例门静脉高压患者术中测压,门静脉压力明显增高,为（33.79±5.32）cm H2O柱,门静脉流量与压力行pearson相关性分析,无明显相关性（r=0.293,P〈0.01）。结论电影MRI肝硬化术前门静脉血流定量可客观显示门静脉系统呈高血流动力学改变,门静脉压力亦可以反映肝硬化严重程度,但门静脉血流量与压力无明显相关性。     

断流术中保留食管旁静脉的临床效果

目的 回顾性分析断流术治疗门静脉高压症时,保留自然形成的病理性扩张的食管旁静脉对自由门静脉压(FPP)、肝功能指标变化和术后近期并发症发生率的影响.方法 收集我院1994年3月～2006年4月门静脉高压症患者169例,分为单纯脾切除组、保留食管旁静脉组(保留组)和不保留食管旁静脉组(不保留组),比较手术前后FPP变化,并比较断流术组间手术前后肝功能指标变化和术后近期并发症发生率.结果 (1)三组手术前后FPP均明显下降(P＜0.05),其中保留组下降幅度最大与不保留组比较有显著差异(P＜0.01);(2)保留组术后近期并发症发生率明显低于不保留组(P＜0.05).结论 保留食管旁静脉的断流术能更有效地降低门静脉压力,并不会使肝功能恶化,且能降低近期并发症发生率.     

胰源性区域性门脉高压症临床诊治

目的探讨胰源性区域性门脉高压症的诊断和治疗方法。方法回顾分析我院10年来共21例胰源性门脉高压的诊断和治疗措施及结果和随访。结果5例胰腺癌患者死于原发病复发转移,1例合并门脉血栓患者死于肠坏死,余无再出血。结论对于胰源性区域性门脉高压症,胰腺病史和胃镜、超声内镜及血管造影等检查发现胃底静脉曲张结合脾肿大及肝功能正常可协助明确诊断。胰源性门脉高压症可以通过脾切除术或同时结合贲门周围血管离断术治愈,但需结合原发胰腺疾病的治疗。     

Effects of combined procedure and devascularization alone on hyperdynamics of the portal venous system in patients with portal hypertension

Shunts and devascularizations have totally different effects on the hemodynamics of the portal venous system. The actual results of pericardial devascularization (PCDV) alone and conventional splenorenal shunt combined with pericardial devascularization (combined procedure, CP) should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics in the portal venous system after CP and PCDV only. In 20 patients who received CP and 18 who received PCDV, hemodynamic parameters of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free portal pressure (FPP) was continuously detected by a transducer during the operations. Compared to the preoperative data, a decreased flow in the portal vein (PVF) [(563.12 ± 206.42) mL/min vs (1080.63 ± 352.85) mL/min, P < 0.05], a decreased portal vein diameter (PVD) [(1.20 ± 0.11) cm vs (1.30 ± 0.16) cm, P < 0.01], a decreased FPP [(21.50 ± 2.67) mmHg vs (29.88 ± 2.30) mmHg, P < 0.01] and an increased flow in the superior mesenteric vein (SMVF) [(1105.45 ± 309.03) mL/min vs (569.13 ± 178.46) mL/min, P < 0.05] were found in the CP group after operation; a decreased PVD [(1.27 ± 0.16) cm vs (1.40 ± 0.23) cm, P < 0.05], a decreased PVF [(684.60 ± 165.73) mL/min vs (1175.64 ± 415.09) mL/min, P < 0.05], a decreased FPP [(24.40 ± 3.78) mmHg vs (28.80 ± 3.56) mmHg, P < 0.05] and an increased SMVF [(697.91 ± 121.83) mL/min vs (521.30 ± 115.82) mL/min, P < 0.05] were observed in the PCDV group. After operation, PVF in the CP group [(563.12 ± 206.42) mL/min vs (684.60 ± 165.73) mL/min, P > 0.05] had no significant decrease, while FPP [(21.50 ± 2.67) mmHg vs (24.40 ± 3.78) mmHg, P < 0.01] had a significant decrease as compared with that in the PCDV group. PVF and FPP could be decreased by both surgical procedures, but the effect of decreasing FPP was much better in the combined procedure than in PCDV alone. Further, there was no significant difference in PVF between the two groups. It is suggested that the combined surgical procedure could integrate the advantages of shunting with those of devascularization, as well as maintaining the normal anatomic structure of hepatic portal system, thus it should be one of the best choices for patients with portal hypertension when surgical interventions are considered.     

经颈静脉肝内门静脉分流术介入治疗原发性肝癌合并门静脉高压症的临床研究

目的探讨原发性肝癌合并门静脉高压患者采用经颈静脉肝内门静脉分流术（TIPS）治疗的价值。方法32例原发性肝癌合并门静脉高压症患者采用TIPS治疗（治疗组）．21例采用药物保守治疗（对照组）,分析手术治疗疗效,随访TIPS组患者出院后的手术并发症出现情况,并随访所有患者的存活时间及死亡原因。结果32例患者手术成功,术后门静脉压力下降（13．1±1.3）mmHg,术后2周复查,食管胃底静脉曲张明显缓解,术后TBIL、ALT测定值与术前比较,差异有统计学意义（P〈0．05）;术后Child评分与术前比较,差异有统计学意义（P〈0．05）,术后随访TIPS组出现肝性脑病6例,支架梗阻4例,患者存活时间为（5．1±1．1）个月,死亡原因为多脏器功能衰竭22例（68．8％）,上消化道出血4例（12．5％）,其他原因6例（18．8％）;对照组患者存活时间为（1．1±0．6）个月,死亡原因为多脏器功能衰竭12例（57．1％）、上消化道出血7例（33.3％）,其他原因2例（9．5％）。结论TIPS手术对原发性肝癌患者合并门静脉高压症的治疗,安全有效,有临床推广应用的价值。     

早期肠内营养支持在门脉高压行TIPS术后患者中的应用价值

目的　研究早期肠内营养支持方案对门脉高压行经颈静脉肝内门-体分流术（TIPS）后患者应激反应水平、肝功能及营养状态的影响。方法　进行前瞻性研究,选取2018年7月至2020年10月期间河南科技大学第一附属医院95例肝硬化门脉高压症TIPS术后患者作为研究对象,采用随机数字表法分为对照组47例和观察组48例。对照组男32例、女15例,年龄（48.32±4.25）岁,给予常规营养支持;观察组男32例、女16例,年龄（49.61±4.41）岁,给予早期肠内营养支持方案。对比两组患者肝功能、应激反应水平、营养状态。计数资料采用χ²检验,计量资料采用t检验。结果　观察组干预后血清白蛋白（Alb）水平为（39.68±4.23）U/L,高于对照组（35.89±4.50）U/L,总胆红素（TBil）水平为（14.22±2.63）μmol/L,低于对照组（18.54±2.15）μmol/L,差异均有统计学意义（均P<0.05）。观察组干预后转铁蛋白（TRF）水平、前白蛋白（PA）水平、预后营养指数（PNI）分别为（2.78±0.30）g/L、（3.33±0.42）g/dl、（58.24±3.34）,均高于对照组（2.53±0.38）g/L、（2.98±0.40）g/dl、（55.62±3.85）,差异均有统计学意义（均P<0.05）。观察组干预后C反应蛋白（CRP）、凝血酶原时间（PT）水平分别为（14.08±3.62）mg/L、（13.42±0.62）s,均低于对照组（20.35±4.25）mg/L、（15.75±0.80）s,差异均有统计学意义（均P<0.05）。结论　早期肠内营养支持方案对肝硬化门脉高压症TIPS术后患者效果确切,能够有效改善患者营养状态和肝功能,降低应激反应水平,具有临床推广价值。     

肝硬化门脉高压症患者胃左静脉组织ET-1和NO的变化与静脉压的关系

目的:探讨肝硬化门脉高压症患者胃左静脉组织中内皮素-1(ET-1)和一氧化氮(NO)比值的变化及其与胃左静脉压力的相关性。方法:放射免疫法和硝酸酶还原法检测肝硬化门脉高压症患者及对照组患者胃左静脉组织中ET-1和NO含量,术中测定胃左静脉压力,比较两组ET-1/NO比值的变化,并对ET-1/NO比值与胃左静脉压力进行相关性分析。结果:门脉高压症患者胃左静脉组织中ET-1/NO比值较对照组明显升高(P<0.05)。ET-1/NO比值与胃左静脉压力呈显著正相关关系(P<0.05)。结论:肝硬化门脉高压症患者存在ET-1和NO失衡,ET-1产生相对过多,可能是门脉高压症形成和发展的重要原因之一。ET-1/NO比值与胃左静脉压力相关,可以用来间接反映门静脉压的高低,从而对预测曲张静脉破裂出血有一定的意义。     

丹参,黄芪对肝硬化门脉高压血流动力学的影响

目的：观察丹参、黄芪对肝硬化门脉高压血流动力学的影响。方法：６７例肝硬化门脉高压患者随机分为常规治疗组和丹参、黄芪治疗组,分别于治疗前及治疗１月、２月、３月监测门静脉内径、脾静脉内径、门静脉血流速度、脾静脉血流速度加快,门静脉血流量、脾静脉血流量减少,与常规治疗组比较有显著差异性。结论：丹参、黄芪能较好地改善肝硬化门脉高压。     

肝硬化患者血氧变化及其临床意义

目的　探讨肝硬化患者血氧变化及其与肝功能损伤、门脉高压的关系。方法　全自动血气分析仪检测 5 0例肝硬化患者、2 0例正常对照者肺泡 动脉血氧分压差 (AaDpO2 )和动脉血氧分压(PaO2 )。结果　肝硬化组AaDpO2 显著高于对照组 (P <0 .0 1) ,PaO2 明显低于对照组 (P <0 .0 1) ,差异非常显著。肝性低氧血症与肝功能损伤、门脉高压密切相关。结论　血氧变化与肝功能状况有明显相关性 ,是一项重要的肝功能状况评估指标     

肝癌合并门脉高压脾功能亢进11例外科治疗

目的 探讨肝癌合并门静脉高压脾功能亢进患者外科治疗的方法。方法 回顾分析2001～2002年经手术治疗的肝癌合并门脉高压脾功能亢进患者11例，切除肝癌病灶同时行脾切除，或加行贲门周围血管离断术。结果 全组无手术死亡。术后并发症有腹水、低钠血症、上消化道出血、腹腔内出血。结论 肝癌合并门静脉高压脾功能亢进一期进行手术治疗是安全可行的。     

门脉高压患者血浆刺激血管内皮细胞Hsp90表达的试验研究

目的:研究肝硬化门静脉高压症患者血浆对血管内皮细胞热休克蛋白(Hsp90)表达的影响,以了解Hsp90在肝硬化门脉高压形成中的作用。方法:应用免疫组织化学染色法检测Hsp90在正常人血浆和肝硬化门静脉高压症患者血浆刺激人脐静脉血管内皮细胞(HUVEC)中的表达情况。结果:通过组织化学染色图像定量分析显示肝硬化患者血浆处理的HUVEC表达的Hsp90平均灰度值为1.925,正常人血浆处理为1.416,经统计学分析肝硬化患者血浆处理HUVEC表达的Hsp90高于正常人血浆处理组(P<0.05)。结论:肝硬化门脉高压血浆可以刺激血管内皮细胞使Hsp90表达增加,Hsp90可能促进肝硬化门脉高压的形成。     

托拉塞米辅治顽固性高血压合并舒张性心力衰竭疗效观察

目的：观察托拉塞米辅治合并舒张性心力衰竭顽固性高血压的疗效。方法将56例舒张性心力衰竭并顽固性高血压患者随机分为观察组和对照组各28例。观察组患者采用托拉塞米联合降压药治疗;对照组患者给予氢氯噻嗪联合降压药治疗。比较2组患者的治疗效果。结果观察组治疗总有效率为89.3％明显高于对照组的67.9％,差异有统计学意义（P ﹤0.05）;病情恶化发生率及不良反应发生率均低于对照组,差异均有统计学意义（ P ﹤0.05）。结论托拉塞米辅治顽固性高血压合并舒张性心力衰竭中有着良好的治疗效果,值得在临床中推广。     

肝硬化门脉高压症大鼠脾脏切除前后的肺泡巨噬细胞吞噬率变化的实验研究

目的：探讨脾切除术对肝硬化门脉高压症(PHT)的肺脏免疫功能影响,评估保脾手术对治疗PHT的优越性;方法：对模型大鼠及脾切除后的模型大鼠的肺泡巨噬细胞进行体外细胞培养;结果：脾切除术后的大鼠的肺泡巨噬细胞(PAM)的吞噬率显著低于对照组大鼠;结论：在治疗PHT时,从机体免疫角度来说保脾手术可能优于脾全切术。     

肝硬化门静脉高压患者血浆肾上腺髓质素的表达及其与血流动力学的关系研究

目的探讨肾上腺髓质素（ADM）在肝硬化门静脉高压患者血浆中的表达及其与血流动力学的关系。方法采用放射免疫法测定82例肝硬化门静脉高压患者血浆中ADM的含量,然后观察其与门静脉血流动力学之间的关系。结果 Pearson相关分析表明,肝硬化门脉高压患者血浆ADM含量与门静脉截面内径（PVD）和门静脉血流量（PVFV）之间呈正相关,与门静脉最大血流速度（PVV）之间呈负相关。结论 ADM的表达水平与肝硬化门静脉高压患者门静脉血流动力学有关,患者血浆中ADM的含量可作为肝硬化门静脉高压的诊断及预后的指标,也为其治疗提供新的靶点。     

Sorafenib targets dysregulated Rho kinase expression and portal hypertension in rats with secondary biliary cirrhosis

Background and purpose

Extrahepatic vasodilation and increased intrahepatic vascular resistance represent attractive targets for the medical treatment of portal hypertension in liver cirrhosis. In both dysfunctions, dysregulation of the contraction-mediating Rho kinase plays an important role as it contributes to altered vasoconstrictor responsiveness. However, the mechanisms of vascular Rho kinase dysregulation in cirrhosis are insufficiently understood. They possibly involve mitogen-activated protein kinase/extracellular signal-regulated kinase (ERK)-dependent mechanisms in extrahepatic vessels. As the multikinase inhibitor sorafenib inhibits ERK, we tested the effect of sorafenib on haemodynamics and dysregulated vascular Rho kinase in rats with secondary biliary cirrhosis.

Experimental approach

Secondary biliary cirrhosis was induced by bile duct ligation (BDL). Sorafenib was given orally for 1 week (60 mg·kg⁻¹·d⁻¹). Messenger RNA levels were determined by quantitative real time polymerase chain reaction, protein expressions and protein phosphorylation by Western blot analysis. Aortic contractility was studied by myographic measurements, and intrahepatic vasoregulation by using livers perfused in situ. In vivo, haemodynamic parameters were assessed invasively in combination with coloured microspheres.

Key results

In BDL rats, treatment with sorafenib decreased portal pressure, paralleled by decreases in hepatic Rho kinase expression and Rho kinase-mediated intrahepatic vascular resistance. In aortas from BDL rats, sorafenib caused up-regulation of Rho kinase and an improvement of aortic contractility. By contrast, mesenteric Rho kinase remained unaffected by sorafenib.

Conclusions and implications

Intrahepatic dysregulation of vascular Rho kinase expression is controlled by sorafenib-sensitive mechanisms in rats with secondary biliary cirrhosis. Thus, sorafenib reduced portal pressure without affecting systemic blood pressure.     

妊高征患者血清C-反应蛋白及肝肾功能变化的临床观察

目的 探讨妊娠高血压综合征（妊高征,PIH）患者血清C-反应蛋白和肝、肾功能的变化规律及其临床意义.方法 选择96例PIH患者（PIH轻度组50例、PIH重度组46例）和50例孕晚期的正常孕妇（对照组）作为观察对象,采用全自动生化分析仪检测所有孕妇的血清C-反应蛋白（CRP）、白蛋白（Alb）、丙氨酸氨基转移酶（ALT）、天门冬氨基转移酶（AST）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、尿素（Urea）、尿酸（UA）、肌酐（Cr）,并对结果进行统计学分析.结果 PIH患者血清CRP水平明显高于对照组孕妇（P＜0.01）,且PIH重度组患者明显高于轻度组（P＜0.01）.两组PIH患者血清Alb含量均较对照组孕妇明显降低,差异具有统计学意义（P＜0.05）,且PIH重度组患者明显低于轻度组（P＜0.05）;PIH患者血清ALT、AST、GGT、ALP和Urea、UA、Cr水平均较对照组孕妇显著升高,差异具有统计学意义（P均＜ 0.05）;PIH重度组患者血清UA和Cr水平明显高于轻度组（P＜0.05）,两组PIH患者之间血清ALT、AST、GGT、ALP和Urea水平差异无统计学意义（P＞0.05）.结论 PIH患者的血清CRP水平升高,与病情的严重程度相关;PIH患者肝、肾功能均受损;血清UA水平随病情加重升幅明显,可作为PIH病情监测的较好指标.     

氨氯地平联合缬沙坦在轻中度高血压患者中的疗效观察

目的 探讨氨氯地平联合缬沙坦治疗轻中度高血压的效果.方法 根据治疗方法的不同将145例轻中度高血压患者分为A组（55例）、B组（45例）、C组（45例）,A组患者接受氨氯地平联合缬沙坦治疗,B组患者接受氨氯地平治疗,C组患者接受缬沙坦治疗.结果 治疗后,A组患者的SBP、DBP均显著低于B、C组（P＜0.05）,但B组与C组患者的SBP、DBP差异均无统计学意义（P＞0.05）;A组患者治疗显效率明显高于B、C组（P＜0.05）,但B组与C组患者的显效率差异无统计学意义（P＞0.05）.结论 氨氯地平联合缬沙坦治疗轻中度高血压的效果显著优于单一药物治疗,联合治疗方案是治疗轻中度高血压的理想方案.     

肝硬化门静脉高压症患者血浆NO和ET-1的临床意义

目的探讨肝硬化门脉高压患者血浆一氧化氮(NO)和内皮素1(ET-1)水平与食管静脉曲张和腹水的关系。方法76例肝硬化患者血浆NO、ET-1与其食管静脉曲张内镜评分、门静脉内径、腹水分级评分、血清白蛋白等四项指标进行非参数统计等级相关分析。结果血浆NO、ET-1与食管静脉曲张程度和门静脉内径呈正相关，与血清白蛋白呈负相关；血浆ET-1与腹水程度呈正相关。结论血浆NO和ET-1参与肝硬化门静脉高压症的病理机制。     

Effect of carteolol on renal function in healthy subjects and patients with hypertension

Summary The effect of short- and long-term administration of carteolol on renal function has been examined in healthy subjects and in hypertensive patients with or without renal failure.In healthy subjects neither a single dose of 10 mg carteolol nor continuous administration of 20 mg/day for 7 days had any effect on creatinine clearance and renal blood flow. In all subjects the clearance rate of carteolol was about 400 ml/min and its fractional excretion of carteolol exceeded 300%, suggesting that the drug is secreted actively from renal tubules.Twenty-three hypertensive patients with or without renal dysfunction were given carteolol 10 to 20 mg/day for more than 50 weeks in addition to their standard antihypertensive regimens, which were left changed. Laboratory results were compared with the mean values of 50 weeks before and after the addition of carteolol, and none, including plasma creatinine, blood urea nitrogen and electrolytes, were significantly changed. Neither the estimated glomerular filtration rate nor the effect of the drug on blood pressure changed significantly during this prolonged treatment.It is concluded that carteolol had no effect on renal function in healthy subjects and in hypertensive patients with or without renal failure.