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目的探讨内皮素（ＥＴ）和一氧化氮（ＮＯ）在重型肝炎（ＳＨ）发病中的作用．方法检测３０例ＳＨ，３２例慢性肝炎（ＣＨ）患者外周血ＥＴ和ＮＯ代谢物ＮＯ－２的水平，并用ＮＯ合成酶底物左旋精氨酸（ＬＡｒｇ）进行治疗前后对比．结果ＳＨ患者外周血ＥＴ和ＮＯ－２水平（１３９ｎｇ／Ｌ±１４ｎｇ／Ｌ，１２７μｍｏｌ／Ｌ±４０μｍｏｌ／Ｌ）明显高于ＣＨ组（８５ｎｇ／Ｌ±１５ｎｇ／Ｌ，６３μｍｏｌ／Ｌ±２５μｍｏｌ／Ｌ，Ｐ＜００１）．合并有Ⅲ，Ⅳ期肝性脑病与肝肾综合征患者外周血ＥＴ和ＮＯ－２水平（１４９ｎｇ／Ｌ±１３ｎｇ／Ｌ，１６２μｍｏｌ／Ｌ±３４μｍｏｌ／Ｌ）明显高于非肝性脑病患者（１１５ｎｇ／Ｌ±１２ｎｇ／Ｌ，８８μｍｏｌ／Ｌ±２４μｍｏｌ／Ｌ，Ｐ＜００１）和Ⅱ期肝性脑病患者（１３６ｎｇ／Ｌ±１０ｎｇ／Ｌ，１２２μｍｏｌ／Ｌ±２６μｍｏｌ／Ｌ，Ｐ＜００１）；ＬＡｒｇ静脉滴注后血浆ＥＴ水平和平均动脉压（ＭＡＰ）显著下降，而肌酐清除率（ｃＣｒ）和尿钠含量明显增加．结论ＥＴ和ＮＯ水平升高是引起ＳＨ多脏器功能障碍的重要因素．ＬＡｒｇ长期治疗可能促进ＳＨ患者脑水肿形成和肝肾综合征发生．
Objective To investigate the role of endothelin (ET) and nitric oxide (NO) in the pathogenesis of severe hepatitis (SH). Methods The levels of NO and NO in peripheral blood of 30 cases of SH and 32 cases of chronic hepatitis (CH) were detected and compared before and after treatment with L-arginine (L-Arg). Results The levels of ET and NO-2 in peripheral blood of SH patients were significantly higher than those of CH group (85ng / L ± 15ng / L, 63μmol / L, 13ng / L ± 14ng / L and 127μmol / L ± 40μmol / L ± 25μmol / L, P <001). The levels of ET and NO-2 in peripheral blood of patients with stage Ⅲ and Ⅳ hepatic encephalopathy and hepatorenal syndrome (149ng / L ± 13ng / L, 162μmol / L ± 3.4μmol / L) were significantly higher than those of non-hepatic The patients with encephalopathy (115ng / L ± 12ng / L, 88μmol / L ± 24μmol / L, P <001) and Ⅱhepatic encephalopathy patients (136ng / L ± 10ng / L, 122μmol / L ± 26μmol / L, P <001). The plasma ET level and mean arterial pressure (MAP) decreased significantly after intravenous infusion of LArg, but the creatinine clearance (cCr) and urine sodium level increased significantly. Conclusions ET and NO levels are the important factors that cause SH multiple organ dysfunction. L Arg long-term treatment may promote the formation of brain edema in patients with SH and hepatorenal syndrome.