TIPS治疗对门静脉高压症患者食管、胃底组织内微血管生成的影响

目的:研究TIPS治疗对门静脉高压症患者食管、胃底组织内微血管生成的影响,探讨血管生成在门静脉高压症食管、胃底静脉曲张形成中的作用。方法:取门静脉高压症Sugiura术患者的食管贲门吻合圈标本78例。(1)PHT组:术前未行TIPS治疗。食管组织118例,胃组织25例;(2)TIPS组:术前曾行TIPS治疗,食管组织5例,胃组织12例。正常食管组织10例、胃组织8例作为对照组。应用免疫组化技术分别检测食管胃底组织内的微血管密度。结果:食管胃底组织微血管高密度区主要位于粘膜固有层,其次为粘膜下层。粘膜固有层微血管密度3组差别无统计学意义(P>0.05);粘膜下层微血管密度PHT组明显高于正常组(P<0．01)和TIPS组(p<0．05),TIPS组和正常组差别无统计学意义(P >0.05)。结论:食管胃底组织内的微血管密度与门静脉压力改变有关。门静脉高压时,食管胃底组织粘膜下层血管生成活跃,可能参与了食管胃底粘膜下静脉曲张的形成;经TIPS治疗后,粘膜下层血管生成减少。

The effect of TIPS on angiogenesis in esophagogastric tissue of patients with portal hypertension

Objective:To investigate the angiogenesis in esophagogastrlc tissue of patients with portal hypertension and its correlation with changes of portal pressure,and explore the role of angiogenesis in the formation of esophagogastric varices in portal hypertension. Methods: Specimens from portal hypertension patients underwent modified Sugiura procedure were divided into two groups. In PHT group, 18 cases of esophageal tissue and 25 cases of gastric tissue were taken from patients untreated with TIPS before operation. In TIPS group,5 cases of esophageal tissue and 12 cases of gastric tissue were taken from patients treated with TIPS before operation. Normal esophageal tissue(10 cases)and gastric tissue(8 cases)served as the control group. Results: Regions of high microvessle density mainly located in the mucosai laminal prop-ria and submucosa of esophagogastric tissue . The MVD of mucosai laminal propria was not significantly different among the three groups (P>0. 05). The MVD of submucosa in PHT group was significantly higher than that in the control group (P<0.03 )and TIPS group (P<0. 05). And there was no significant difference in the MVD of submucosa between TIPS group and the control group (P>0. 05). Conclusion: The angiogenesls in esophagogastric tissue is related with changes of portal pressure. There exists active angiogenesis in the submucosa of esophagogastric tissue in portal hypertension. While the angiogenesis becomes inactive after TIPS. the MVD of submucosa the expression of VEGF increases in portal hypertension while decreases after TIPS. The increased expression of VEGF may contribute to the formation of esophagogastric varices in portal hypertension. These neogenetic vessels may contribute to the formation of esophagogastric varices.