CD40在肝硬化门静脉高压症脾脏中的表达与临床意义

Objective To investigate the expression and clinical significance of CD40 in the spleen of cirrhotic portal hypertension. Methods Expression of CD40 was determined with S-P immunohistochemistry in spleen specimens from 50 cases of cirrhotic portal hypertension and 15 healthy individuals. Results The CD40 positive rates in normal spleen and cirrhotic spleen were 86.7% and 36.0%, respectively. There was a significant difference between the 2 groups (P＜0.05). There was a negative correlation between the expression of CD40 and Child grades of liver function and cirrhotic splenic types(P＜0. 05). Conclusion CD40 might reflect the changes of splenic immune function,which might be one of more exact clinical examination indexes of splenic immune function.     

脾动脉缩窄对门静脉高压大鼠脾脏iNOS表达及Th1/Th2平衡的影响

Objective To investigate the effect and the potential mechanism of splenic artery coarctation on the expression of iNOS and Th1/Th2 cytokines in spleen of cirrhotic rats with portal hypertension (PHT). Methods Cirrhotic rats were randomized into 3 groups (n= 10):sham operation group (SOG), splenic artery coarctation group (SAC) and splenic artery ligation group (SAL). Ten normal rats treated with sham operation were employed to serve as normal control group (NCG). Immunohistochemial staining was used to observe iNOS. RT-PCR was used to detect IFN-γ and IL-4mRNA. The Pearson's correlation analysis was used to investigate the relationship between iNOS and IFN-γ or IL-4. Results The expression of iNOS was increased significantly in spleen of cirrhotic rats as compared with NCG(P＜0. 01). It was decreased after SAC and SAL compared with SOG (P＜0. 01). The expression of IFN-γmRNA and IFN-γ/IL-4 of SOG were decreased but IL-4mRNA increased significantly than that of NCG(P＜0.01). IFN-γmRNA was increased after SAC compared with SOG (P＜0.05). IL-4mRNA was decreased and IFN-γ/IL-4 increased after SAC and SAL compared with SOG (P＜0. 05). The expression of iNOS was negatively correlated with the expression of IFN-γmRNA(r=-0.672, P＜ 0.01 ) and positively correlated with the expression of IL-4 mRNA (r=0.634,P＜0. 01). Conclusion The expression of iNOS is decreased and IFN-γ/IL-4 increased after SAC in spleen of cirrhotic rats with PHT and it may improve Th1/Th2 polarization by reducing the expression of iNOS.     

脾动脉缩窄对门静脉高压大鼠脾脏iNOS表达及Th1/Th2平衡的影响

Objective To investigate the effect and the potential mechanism of splenic artery coarctation on the expression of iNOS and Th1/Th2 cytokines in spleen of cirrhotic rats with portal hypertension (PHT). Methods Cirrhotic rats were randomized into 3 groups (n= 10):sham operation group (SOG), splenic artery coarctation group (SAC) and splenic artery ligation group (SAL). Ten normal rats treated with sham operation were employed to serve as normal control group (NCG). Immunohistochemial staining was used to observe iNOS. RT-PCR was used to detect IFN-γ and IL-4mRNA. The Pearson's correlation analysis was used to investigate the relationship between iNOS and IFN-γ or IL-4. Results The expression of iNOS was increased significantly in spleen of cirrhotic rats as compared with NCG(P＜0. 01). It was decreased after SAC and SAL compared with SOG (P＜0. 01). The expression of IFN-γmRNA and IFN-γ/IL-4 of SOG were decreased but IL-4mRNA increased significantly than that of NCG(P＜0.01). IFN-γmRNA was increased after SAC compared with SOG (P＜0.05). IL-4mRNA was decreased and IFN-γ/IL-4 increased after SAC and SAL compared with SOG (P＜0. 05). The expression of iNOS was negatively correlated with the expression of IFN-γmRNA(r=-0.672, P＜ 0.01 ) and positively correlated with the expression of IL-4 mRNA (r=0.634,P＜0. 01). Conclusion The expression of iNOS is decreased and IFN-γ/IL-4 increased after SAC in spleen of cirrhotic rats with PHT and it may improve Th1/Th2 polarization by reducing the expression of iNOS.     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

脾动脉缩窄对门静脉高压大鼠脾脏iNOS表达及Th1/Th2平衡的影响

目的 观察脾动脉缩窄对肝硬化门静脉高压大鼠脾脏iNOS、Th1/Th2型细胞因子表达的影响,并探讨机制.方法 肝硬化门静脉高压大鼠随机分3组(n=10):假手术组(SOG)、脾动脉缩窄术组(SAC)和脾动脉结扎术组(SAL);正常大鼠10只行假手术作为对照组(NCG).免疫组化法测脾脏iNOS表达,RT-PCR法测脾脏IFN-γ、IL-4mRNA表达,对iNOS与IFN-γ、IL-4表达量作相关分析.结果 SOG脾脏iNOS明显高于NCG(P＜0.01),SAC和SAL明显低于SOG(P＜0.01).SOG脾脏IFN-γmRNA和IFN-γ/IL-4明显低于NCG(P＜0.01),IL-4mRNA明显高于NCG(P＜0.01);SAC脾脏IFN-γmRNA高于SOG(P＜0.05),SAC和SAL脾脏IL-4mRNA低于SOG(P＜0.05),而IFN-γ/IL-4高于SOG(P＜0.05).iNOS与IFN-γ负相关(r=-0.672,P＜0.01),与IL-4正相关(r=0.634,P＜0.01).结论 脾动脉缩窄术后门静脉高压大鼠脾脏iNOS表达降低,IFN-γ/IL-4升高,脾脏Th1/Th2失衡改善可能与术后iNOS表达降低有关.     

脾大部切除及食管横断吻合术治疗肝硬化门静脉高压症的血流动力学研究

目的 评价脾大部切除、残脾腹膜后包埋及食管横断吻合术对肝硬化门静脉高压症患者门静脉血流动力学的影响.方法 将40例门静脉高压症患者随机分为研究组和对照组,每组20例.均进行食管横断吻合术,对照组做全脾切除,研究组保留部分带血管蒂脾脏移植于腹膜后.手术前后用三维动态增强磁共振血管成像测量门静脉主干的管腔横截面面积、血流量、血流速度和流向;观察自体移植脾在腹膜后的血供及侧支循环.结果 两组术前均存在胃底食管曲张静脉,术后6个月MRA复查均消失或改善.术后6个月两组门静脉主干的管腔横截面积明显减少[研究组(1.81±0.73)cm~2比(1.20±0.52)cm~2,P＜0.01;对照组(1.78±0.52)cm~2比(1.30±0.12)cm~2,P＜0.01];术后两组门静脉主干的平均流速均下降[研究组(9.86±0.10)cm/s比(7.06±1.92)cm/s,P＜0.01;对照组(10.0±0.6)cm/s比(8.2±2.4)cm/s,P＜0.01],且研究组少于对照组(P＜0.01);术后两组门静脉主干的平均流量均下降[研究组(15.0±1.9)ml/s比(10.5±2.7)ml/s,P＜0.01;对照组(14.9±2.1)mI/s比(11.6±2.1)ml/s,P＜0.01],且研究组少于对照组(P＜0.05).移植脾在腹膜后成活,并建立了广泛的侧支循环.结论 脾大部切除、带血管蒂残脾腹膜后移植及食管横断吻合术治疗肝硬化门静脉高压症不仅保留了脾脏的功能,而且具有断流和分流为一体的联合性术式的作用.     

Effects of splenic artery occlusion on portal pressure in patients with cirrhosis and portal hypertension.

The specific contribution of splenic blood inflow to portal hypertension in patients with cirrhosis is still unclear. In this study, we investigated this contribution by assessing the hemodynamic effects of transient splenic artery occlusion. In 15 cirrhotic patients, portal pressure gradient (PPG) was measured just before inserting a transjugular intrahepatic portosystemic shunt (TIPS), in baseline conditions, for 15 minutes after splenic artery occlusion and 5 minutes after recovery. Splenic artery occlusion caused a significant decrease in PPG (range, -4% to -38%, median -20%, P < 0.001) which promptly returned to baseline values after recovery of the splenic inflow. The decrease in PPG showed a significant correlation with spleen volume (r = 0.70, P < 0.005), liver volume (r = -0.63; P < 0.01), and spleen/liver volume ratio (r = 0.82, P < 0.001). Seven out of eight patients with a spleen/liver volume ratio greater than 0.5 had a marked decrease in PPG (>20%), whereas none of patients with a ratio lesser than 0.5 had a marked PPG response. In conclusion, in cirrhotic patients with portal hypertension, splenic artery occlusion causes a significant reduction in portal pressure (PPG). The drop in PPG is directly related to spleen volume and indirectly related to liver volume. The spleen/liver volume ratio accurately predicts the drop in PPG and may be used to identify patients who could obtain a significant advantage from surgical and nonsurgical procedures decreasing splenic inflow.     

The value of partial splenic autotransplantation in patients with portal hypertension: a prospective randomized study.

HYPOTHESIS: Splenic autotransplantation plays a role in preserving immune function of the spleen in patients with portal hypertension and liver cirrhosis. DESIGN: Prospective randomized study. SETTING: University hospital. PATIENTS: Twenty patients (19 men and 1 woman; aged 33-80 years) suffering from portal hypertension and liver cirrhosis were randomly allocated into 2 groups. Each group consisted of 10 patients. INTERVENTIONS: All patients underwent modified Sugiura operation. In the control group, splenectomy was performed, while partial splenic autotransplantation into the retroperitoneal space was additionally completed in the splenic autotransplantation group. MAIN OUTCOME MEASURES: Serum tuftsin and IgM were measured preoperatively and 2 months after surgery. Dynamic scintigraphy with technetium Tc 99m-labeled heat-damaged erythrocytes was performed at 2-month intervals during the 8-month follow-up. RESULTS: There was no statistical difference in the mortality of the groups. The preoperative levels of serum tuftsin and IgM showed no statistical difference between groups. However, although these measures had decreased remarkably in the control group 2 months after operation (P<.001 for serum tuftsin; P =.04 for serum IgM), they remained stable in the splenic autotransplantation group (P =.25 for serum tuftsin; P =.12 for serum IgM). Four patients within the splenic autotransplantation group showed positive scanning of the transplanted splenic fragment during follow-up, whereas there was no positive scanning in the control group. CONCLUSION: Our results suggest that partial splenic autotransplantation can preserve immune function of the spleen, as measured by serum levels of tuftsin and IgM, in patients with portal hypertension and liver cirrhosis.     

联合介入栓塞治疗门静脉高压症的临床研究

摘要：目的:探讨经皮经肝食管胃底静脉栓塞术（PTVE）联合部分脾脏栓塞术（PSE）治疗肝硬化门静脉高压症的临床效果。方法:采用经皮经肝TH胶定位栓塞胃冠状静脉（必要时联合栓塞胃短和胃后静脉）联合脾部分栓塞术,治疗肝硬化门静脉高压症并上消化道出血患者66例，以54例采用断流加脾次全切除腹膜后移位术的患者为对照，进行对比研究。随访2~60个月，平均20个月。结果:（1）研究组急诊止血率100%，再出血率3.3%；对照组急诊止血率100%，再出出血率4.8%。两组比较均无显著性差异（均P＞0.05）。（2）门静脉高压性胃病（PHG）: 研究组栓塞后2个月和1年与栓塞前相比，无明显变化（P＞0.05）；对照组术后2个月比术前加重（P＜0.05），术后1年比术前减轻（P＜0.05）；研究组与对照组相比，PHG的变化无显著性差异（P＞0. 05）。（3）术后1年食管胃底静脉曲张：研究组54中好转59.3%(32/54)，消失20.4%(11/54)，无变化18.5%(10/54)，加重1.8%(1/54)；对照组中，好转52%(26/50)，消失20%(10/50)，无变化28%(14/50)，两组疗效相似（P＞0.05）。（4）自由门静脉压力（FPP）：两组治疗结束时均较术前明显下降（P＜0.05），研究组平均减少（2.55±6.93）cmH2O，对照组平均减少（2.46±7.07）cmH2O两组间无显著性差异（P＞0.05）。结论:联合介入栓塞术止血确切，降低门脉压力显著，再出血率低，能够消除脾亢，保留脾功能，达到与断流加脾次全切除腹膜后移位术相似的疗效；且创伤小，适应证宽。     

YKL-40蛋白与门静脉高压脾脏肿大纤维化重塑进程的研究

目的：探讨YKL-40蛋白在人门静脉高压脾脏组织中的表达及临床意义。 方法：采用免疫组织化学法检测人正常脾脏组织14份及门静脉高压脾脏组织48份中YKL-40蛋白表达情况,Masson三色染色检测脾脏纤维化程度。 结果：门静脉高压患者脾脏YKL-40蛋白表达明显高于正常脾脏,两组YKL-40表达差异具有统计学意义（P 〈 0.05）,且其表达程度随Child-Pugh分级增高而增高（P 〈 0.05）。YKL-40蛋白表达与患者自由门静脉压力（FPP）呈正相关（R = 0.499,P 〈 0.01）。门静脉高压脾脏中纤维增生较正常脾脏增生明显（P 〈 0.05）,YKL-40蛋白表达与纤维化程度呈正相关（R = 0.857,P 〈 0.01）。 结论：YKL-40在门静脉高压脾脏中表达增高,且表达水平与FPP、Child-Pugh分级相关。YKL-40表达与脾脏纤维化程度成正相关,提示YKL-40可能参与门静脉高压脾脏纤维化重塑过程。YKL-40蛋白可能成为治疗门静脉高压脾大的重要生物治疗因子。     

术前高压氧治疗对肝硬化门静脉高压症病人的影响

目的 研究术前高压氧（HBO）治疗对肝硬化门静脉高压病人的作用,并探讨其机理。方法 选取肝硬化门静脉高压病人12例接受HBO治疗。观察肝功指标、内毒素和NO水平、肠粘膜通透性、网状内皮系统功能及血流动力学指标在HBO前后变化;另设正常对照组8例,比较两组间肠粘膜通透性、网状内皮系统功能的差异。结果 （1）与正常秩序正常组相比,肝硬化组的肠粘膜通透性增高,而网状内皮系统吞噬功能降低,且内毒素与肠粘膜通透性呈正相关（r＝0．504,P＝0．012）。（2）HBO治疗后,病人的肝功改善;网状内皮系统功能恢复,内毒素、NO较前下降;脾脏厚度、门静脉宽度及门静脉血流量减少。（3）统计分析发现NO与内毒素、脾脏厚度及门静脉血流速度呈正相关（r1＝0．597,P1＝0．000;r2＝0．472,P2＝0．027;r3＝0．463,P3＝0．030）,与门静脉血流速度呈负相关（r＝－0．443,P＝0．030）。结论 HBO能改善肝硬化病人的肝脏功能,改善门静脉高压和高动力循环状态。其作用机理可能与改善肝脏供氧,增加网状内皮系统功能,减少血中内毒素及NO有关。     

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目的探讨肝硬变门静脉血流动力学的变化及断流术对其影响。方法应用彩色多普勒流速剖面(CDVP)技术检测69例肝硬变和46例正常人门静脉主干(PT)、右前支(RAB)及脾静脉(SV)的最大截面平均流速(CS-Vmax)、流量、淤血指数(CI)。对其中行断流术的28例,比较术前、术后各血流动力学指标间的差异。结果肝硬变组PT、RAB的CS-Vmax较正常组显著减慢,PT、SV的流量及SV与PT流量比(SV/PT)较正常组显著增高,PT、RAB及SV的CI均比正常组显著增高。断流术后PT流量显著减少(P＜0.01),减少幅度与术前SV流量显著相关(r=0.65,P＜0.001);RAB的CS-Vmax和流量均明显下降(P＜0.01),流量下降幅度与术前流量呈高度相关(r=0.74,P＜0.001);术后门静脉自由压(FPP)下降(0.59±0.49)kPa[(6.0±5.0)cmH2O](P＜0.001)。术前、术后PT、RAB的CI值,PT的CS-Vmax未发现明显变化。结论肝硬变时门静脉系处于阻力增高和高动力循环并存状态,但不同血管表现侧重不同。SV高动力循环是门静脉血流量增加的主要来源。断流术治疗的主要机制之一是有效地缓解了门静脉系的高动力循环状态。但断流术不能改变高阻力状态,高动力循环的缓解使进入肝内的门静脉血流更加减少,可能对术后肝功能的维护不利。     

Caspase-9表达对肝硬化门静脉高压中巨脾形成的作用机制探讨

目的：探讨Caspase-9在肝硬化门静脉高压巨脾中的表达及对其形成的作用机制。方法：采用免疫组织化学SP法测定50例肝硬化门静脉高压患者巨脾和15例正常人外伤脾脏组织中Caspase-9的表达情况。结果：Caspase-9在外伤脾脏及巨脾组织中阳性表达率分别为26.7%和76.0%,差异有统计学意义（P〈0.05）。Caspase-9阳性表达与肝功能Child分级及巨脾病理分级均呈正相关（r=0.834,P〈0.05）。结论：Caspase-9参与了肝硬化门静脉高压中脾肿大及脾功能亢进的发生、发展过程。     

自体脾移植联合食管横断吻合术治疗肝硬化门静脉高压症

目的 本研究比较自体脾移植联合食管横断吻合术与脾切除联合食管横断吻合术治疗门静脉高压症(PHT)的疗效.方法 将30例研究对象平均分为两组.研究组行脾次全切除加自体脾腹膜后移植及食管横断吻合术;对照组行脾切除加食管横断吻合术.于术前1周及术后6个月通过三维动态增强磁共振血管成像(3D DCE MRA)检测其门静脉主干(MPV)管腔横截面积、血流量、血流速度等门静脉系统血流动力学参数及食管胃底曲张静脉的变化,并观察自体移植脾在腹膜后的侧支血管形成与血流方向的改变.并同步检查血清肝纤维化指标及肝功能的重要指标. 结果术后两组MPV的管腔横截面积、MPV的平均流速和MPV的平均流量均比术前明显减小(P＜0.05).且术后研究组MPV的平均流速和平均流量均少于对照组(P＜0.05).两组手术后胃底曲张静脉、食管曲张静脉均消失或明显改善;两组手术前后肝功能的重要指标均差异无统计学意义(P＞0.05).研究组血清透明质酸水平在术后显著下降(P＜0.05),研究组移植脾成活良好,并建立了广泛的侧支循环. 结论自体脾移植联合食管横断吻合术是一种优于脾切除加断流术治疗肝硬化PHT的方法,且未对肝功能造成负面影响.