乙型肝炎性肝硬化患者血浆肽类激素变化的临床观察

采用放射免疫分析法测定空腹血浆的激素含量,观察乙型肝炎性肝硬化时血浆肽类激素变化,探讨其对血液动力学和钠水潴留的影响.结果显示肝硬化失代偿期患者胃动素、P物质、精氨酸加压素、内皮素、肾上腺髓质素和内源性类洋地黄物质的空腹血浆含量均明显高于对照组(P＜0.01),与肝功能Child分级呈正相关,伴腹水者血浆某些激素含量更高于无腹水者.而肝硬化时空腹血浆甘丙素、降钙素基因相关肽含量显著低于对照组(P＜0.01).肝硬化伴腹水者尿钠显著低于无腹水者(P＜0.05)和对照组(P＜0.01).提示乙型肝炎性肝硬化患者血浆肽类激素水平发生了明显改变,与门脉血管高阻力、内脏充血、全身性高动力循环和钠水潴留之间有着密切关系.

Clinical Study on Changes of Plasma Peptide Hormone Levels in Patients with Post Hepatitic B Cirrhosis

To observe the changes of plasma peptide hormone levels in patients with posthepatitic B cirrhosis, and discuss their influence on hemodynamic as well as retention of sodium and water, RIA method was used to determine the plasma hormone levels in the patients with cirrhosis and in healthy control group. In decompensated period of the cirrhosis, the fasting plasma levels of Motilin, Substance P, Arginine vasopressin, Endothelin, Adrenomedullin and Endogenous digoxin like substance were higher than those in the control group ( P <0 01). Some of them were closely correlated with child grading of liver function. The plasma hormone levels in the patients with ascites were increased as compared with those without ascites. However, in the patients with cirrhosis, the fasting plasma concentrations of Galanin and Calcitonin gene related peptide were significantly lower than in the control group ( P <0 01). Otherwise, sodium concentration in urine of the patients with ascites was significantly lower than those without ascites ( P <0 05) and in the control group ( P <0 01). The circulating peptide hormone levels changed significantly during posthepatitic B cirrhosis, which was obviously associated with high resistance of portal vascular system, visceral congestion, and systemic hyperdynamic circulation as well as retention of sodium and water.