门静脉压力改变对门静脉高压症肠道通透性的影响

目的　观察门静脉压力改变对门静脉高压症患者肠道通透性的影响。　方法　门静脉高压症患者 2 0例分为 2组 ,每组 10例 ,A组采用经颈内静脉肝内门体分流术 (transjugularintrahepaticportosystemicshunt,TIPS)加改良Sugiura联合治疗 ,B组行改良Sugiura治疗。分别于术前、TIPS后 2周和改良Sugiura术后 2周行肠道通透性检查 ;2 0例健康志愿者作对照。　结果　门静脉高压症患者较健康志愿者肠道通透性明显升高 (0 132± 0 110vs 0 0 32± 0 0 18,P <0 0 1)。A组患者TIPS术后 2周门静脉压力和肠道通透性均显著降低 (P <0 0 5 ) ;改良Sugiura术后 2周 ,2者无显著变化 ,但较术前明显降低 (P <0 0 5 )。B组患者改良Sugiura术后 2周肠道通透性和术前相比无显著变化。A、B组患者术前肠道通透性相比无显著差异 ,改良Sugiura术后 ,A组明显降低 (P <0 0 5 )。研究还发现门静脉压力与肠道通透性之间有显著相关性 (r=0 6 2 7,P <0 0 1)。　结论　研究表明TIPS加改良Sugiura术降低门静脉压力 ,改善肠道通透性 ,提高临床疗效。

Influences of portal pressure change on intestinal permeability in patients with portal hypertension

OBJECTIVES: To investigate intestinal permeability in patients with portal hypertension and to search for a relationship with portal pressure. METHODS: Twenty patients with portal hypertension were divided two groups (A, B), 10 patients per group. In group A patients were treated with combined TIPS and modified Sugiura. In group B, patients were treated with modified Sugiura only. Intestinal permeability was assessed before operation, two weeks after TIPS, and two weeks after modified Sugiura, and 20 healthy control subjects were also assessed. RESULTS: Intestinal permeability was significantly higher in patients with portal hypertension than in healthy controls (0.132 +/- 0.110 vs. 0.032 +/- 0.018, P < 0.01). In group A, portal pressure and intestinal permeability decreased two weeks after TIPS (P < 0.05) and no obvious change was noted two weeks after modified Sugiura; but they were significantly lower than those before TIPS (P < 0.05). In group B intestinal permeability was not different before and after operation. Intestinal permeability in group A was not different from that in group B before treatment, but significantly lower after modified Sugiura (P < 0.05). Portal pressure was significantly correlated with intestinal permeability (r = 0.627, P < 0.01). CONCLUSIONS: This study shows that combined TIPS and modified Sugiura can lower portal pressure and intestinal permeability, and enhance the therapeutic efficacy on portal hypertension.