一氧化氮在门静脉高压症发病中的作用

目的　探讨一氧化氮在门静脉高压症发病中的作用。　方法　 75例门静脉高压症患者 ,术中胃网膜静脉插管测定门静脉压力 ,检测外周动静脉和门静脉血中内毒素和NO2 -/NO3-的含量。　结果　 ( 1)门静脉高压症患者的血中内毒素和NO2 -/NO3-的水平 [( 0 2 4 9± 0 112 )Eu/ml和( 5 5 9± 2 6 2 ) μmol/L]均显著高于对照组 ,且门静脉血中水平最高。 ( 2 )门静脉高压症患者门静脉压力[( 3 5 5± 4 4 )cmH2 O]与门静脉血NO2 -/NO3-的水平呈显著正相关 (n =2 5 ,r =0 5 5 ,P <0 0 1) ,二者在术后的变化量也呈正相关 (r =0 5 7,P <0 0 5 )。 ( 3 )门静脉高压症患者白蛋白水平与NO2 -/NO3-呈负相关 (n =75 ,r=- 0 3 5 ,P <0 0 1) ,且有腹水组的NO2 -/NO3-水平 [( 72 4± 2 0 3 ) μmol/L]较无腹水组 [( 5 0 3± 2 1 0 ) μmol/L]为高。　 结论　门静脉高压症患者血中内毒素和NO的水平升高 ,后者可能参与了门静脉压力的异常升高且与肝功能损害有关。

The role of nitric oxide in the pathogenesis of portal hypertension

OBJECTIVE: To investigate the role of nitric oxide in the pathogenesis of portal hypertension. METHODS: We measured the portal venous pressure of 75 patients via a catheter and detected the levels of plasma endotoxin and NO(2)(-)/NO(3)(-). RESULTS: The mean levels of plasma endotoxin and NO(2)(-)/NO(3)(-) (0.249 +/- 0.112 Eu/ml and 55.9 +/- 26.2 micromol/L) in portal hypertensive patients were significantly higher than those in the controls, and the highest values were observed in the portal venous blood. The mean portal venous pressure of the portal hypertensive patients was 35.5 +/- 4.4 cm H(2)O and was positively correlated with the levels of NO(2)(-)/NO(3)(-) (n = 25, r = 0.55, P < 0.01). Positive correlation existed between them during the postoperative period (r = 0.57, P < 0.05). There was a negative correlation between the levels of albumin and NO(2)(-)/NO(3)(-) (n = 75, r = -0.35, P < 0.01), and the mean levels of NO(2)(-)/NO(3)(-) were 72.4 +/- 20.3 micromol/L in the patients with ascites, much higher than those (50.3 +/- 21.0 micromol/L) without ascites. CONCLUSIONS: The levels of plasma endotoxin and nitric oxide were elevated in patients with portal hypertension, and NO might play an important role in the abnormal elevation of portal venous pressure and the damage to liver function.