脾切除对大鼠肝纤维化影响的实验研究

目的 研究脾脏对实验性大鼠肝纤维化的影响，探讨脾切除的应用价值。方法 利用四氯化碳和乙醇诱导Wistar大鼠肝纤维化及肝硬化模型。从造模前、肝纤维化期（早期肝硬化期）、肝硬化期三个层面观察脾切除组、脾大部切除组肝纤维化四项指标与肝组织病理改变的关系，以血常规三项指标动态观测整个实验中脾功能状态，并观察对比脾大部切除前后脾脏病理改变。结果 血清HA、CV、IV、PCⅢ与肝纤维化各个时期病理改变有相关性，血清LN与血清HA、CV、IV、PCⅢ变化趋势相同，但敏感性较差，从敏感性与特异性综合考虑可见血清HA〉CV、IV〉PCⅢ〉LN、PLT、WBC、RBC与脾功能之间有很好的相关性，但敏感性RBC逊于PLT、WBC。脾切除可明显减缓肝纤维化诱导进程，对已形成的肝纤维化模型亦有一定的缓解作用。结论 在减缓和逆转肝纤维化中脾切除术作用明显。当脾脏发生病理改变至脾功亢进时引起贫血，并明显促进肝硬化，似予全部切除为佳。血清肝纤维化四项指标HA、CV、IV、PCⅢ、LN与肝纤维化的病理诊断有良好的一致性，可作为无损伤诊断的依据，推荐前三项指标联合应用。PLT、RBC、WBC与肝纤维化及脾功亢进有较好的相关性，可作为临床评估脾亢分级的参考指标，其中PLT、WBC在肝纤维化及脾功亢进形成过程中变化较早且较为明显。

Effects of splenectomy on liver fibrosis in rats

Objective To investigate the effects of splenectomy on liver fibrosis in rats and explore the value of splenectomy.Methods Liver fibrosis(cirrhosis) was induced in Wistar rats with carbon tetrachloride and ethanol.The serum level of hyaluronic acid(HA),collagen type IV(CV IV),precollagen type III(PCIII),laminin(LN),changes hepatic tissue pathology,RBC,WBC,PLT were comprehensively evaluated among all groups in different phases.Results The serum levels of HA,CV IV,PCIII and LN in the model groups were significantly higher than those in control groups(P<0.05).The pathological changes were correspondingly more conspicuous in the model groups than in the control groups.The differences in serum levels of HA,CV IV and PCIII were more meaningful than those of serum LN(P<0.05). In the course of inducing models,the levels of PLT and WBC decreased earlier than those of RBC(P<0.05).After splenectomy and subtotal splenectomy,the levels of PLT and RBC were markedly higher in the model groups than in the control groups.However,they were not remarkably higher in the splenectomy groups than in the subtotal splenectomy groups.Conclusions The changes in serum fibrosis markers are consistent with hepatic tissue pathology,especially serum HA,CV IV and PCIII.Splenectomy can delay the progress of liver fibrosis and reverse the early liver cirrhosis.The levels of RBC,WBC and PLT can reflect the splenic function.Splenectomy should be chosen for portal hypertension when the splenic fibrosis and hypersplenism appear.