乌司他丁对门脉高压症出血病人肝功能的保护作用

目的　探讨门脉高压症出血病人肝功能变化情况 ,同时评价应用乌司他丁 (Ulinastatin ,UTI)治疗的效果。方法　将 4 6例肝硬化门脉高压症出血病人分为两组 :Ⅰ组 (n =2 2 )为一般治疗组 ,Ⅱ组 (n =2 4 )为UTI治疗组 ,分别检测Ⅰ、Ⅱ组出血后 1,2 ,4 ,7,10 ,14d血ET变化情况 ,并检测1,7,14d的肝功能。另选肝硬化门脉高压症未出血病人 (n =2 0 ) ,检测血浆ET ,作为对照组。结果　出血后 7,14d ,Ⅰ、Ⅱ组总胆红素 (TBIL)均呈先升高后下降 ,但Ⅱ组较Ⅰ组下降快 (分别P <0 0 5 ,P <0 0 1)。ALT、AST亦呈先升高后下降 ,但于出血后 14日Ⅱ组较Ⅰ组下降快 (P <0 0 5 )。Ⅰ、Ⅱ组出血后 1d血ET浓度较对照组显著升高 (P <0 0 1) ,随后逐步下降。Ⅱ组ET下降较Ⅰ组快 ,于出血后 2d(P <0 0 5 )、4d (P <0 0 1)、7d(P <0 0 5 )有显著差异。出血后 1dⅠ、Ⅱ组ET浓度与TBIL呈正相关 (r=0 734,P <0 0 1) ;Ⅰ、Ⅱ组血ET下降指数与TBIL增高指数呈负相关 (r =- 0 4 86 ,P <0 0 5 )。结论　肝硬化门脉高压症大出血后应用UTI治疗可抑制TBIL、ALT、AST、ET等的升高 ,起到保护肝脏功能的作用。

Protective effects of ulinastatin on liver function in portal hypertensive patients with hemorrhage

Objective To investigate variations of liver function and evaluate the therapeutic effects of ulinastatin (UTI) in portal hypertensive patients with esophageal variceal hemorrhage. Methods A total of 46 patients with portal hypertension were divided into 2 groups. The patients in group A ( n =22) received general therapy and those in group B (n =24) received the general therapy and UTI after hemorrhage. The plasma ET concentration was measured on the 1st, 2nd, 4th, 7th, 10th and 14th d and liver function determined on the 1st, 7th and 14th d after the hemorrhage. Other 20 patients without the hemorrhage were employed to serve as the control group. Results ON the 7th and 14th d after hemorrhage, the levels of TBIL, ALT and AST were elevated firstly and then decreased in groups A and B. The decrease of TBIL, ALT and AST levels was significantly faster in group B than in group A ( P <0.05 and 0.01) on the 14th d after hemorrhage. On the 1st day after the hemorrhage, the ET concentration was markedly increased in groups A and B as compard with the control group ( P <0.01). Then it was gradually decreased on the 10th d after hemorrhage. Meanwhile, the ET concentration was positively correlated to TBIL level in groups A and B ( r=0.734, P<0.01) and the decrease index of ET concentration was negatively correlated to increase index of TBIL in the 2 groups ( r=-0.486, P <0.05). Conclusions UTI can protect liver function by inhibiting increase of ALT, AST and TBIL levels in portal hypertensive patients with hemorrhage.