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目的探讨门静脉高压症出血患者血内皮素(ET)变化及意义。方法66例门静脉高压症出血患者随机分为2组:Ⅰ组(n=32)为一般治疗组,Ⅱ组(n=34)为乌司他丁(UTI)治疗组,检测Ⅰ、Ⅱ组出血后1、2、4、7、10、14d血ET变化,并检测1、7、14d的肝功能。另选门静脉高压症未出血患者(n=20),检测血ET,作为对照组。结果出血后7、14d,Ⅰ、Ⅱ组总胆红素(TBIL)、谷丙转氨酶(ALT)、天冬氨酸转氨酶(AST)均呈先升高后下降,但于出血后14dⅡ组较Ⅰ组下降快(P<0.05;P<0.01;P<0.05)。Ⅰ、Ⅱ组出血后1d血ET浓度较对照组显著升高(P<0.01),随后逐步下降。Ⅱ组ET下降较Ⅰ组快,于出血后2d(P<0.05)、4d(P<0.01)、7d(P<0.05),差异有统计学意义。出血后1dⅠ、Ⅱ组ET浓度与总胆红素(TBIL)呈正相关(r=0.734,P<0.01);Ⅰ、Ⅱ组血ET下降指数与TBIL增高指数呈负相关(r=-0.486,P<0.05)。结论门脉高压症大出血后ET升高对肝功能的损害有重要作用,应用UTI治疗可抑制TBIL、ALT、AST、ET等的升高。
Objective To investigate the changes and clinical significance of blood endothelin (ET) in patients with portal hypertension. Methods Sixty-six patients with portal hypertension were randomly divided into two groups: group Ⅰ (n = 32), general treatment group Ⅱ (n = 34), ulinastatin (group UU) After 1, 2, 4, 7, 10 and 14 days, blood ET level was measured, and hepatic function was detected at 1, 7 and 14 days. Another patient with portal hypertension without hemorrhage (n = 20), ET was detected as a control group. Results The levels of total bilirubin (TBIL), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased at first and then decreased at 7 and 14 days after hemorrhage, Group decreased rapidly (P <0.05; P <0.01; P <0.05). The levels of ET on the 1st day after hemorrhage in group Ⅰ and Ⅱ were significantly higher than those in control group (P <0.01), and then gradually decreased. The decrease of ET in group Ⅱ was faster than that in group Ⅰ, and the difference was statistically significant at 2 days (P <0.05), 4 days (P <0.01) and 7 days after hemorrhage (P <0.05). On the 1st day after hemorrhage, the concentration of ET in group Ⅱ was positively correlated with total bilirubin (r = 0.734, P <0.01); the level of ET in group Ⅰ and Ⅱ was negatively correlated with the increase of TBIL (r = -0.486, P <0.05). Conclusions ET after hemorrhagic portal hypertension has an important effect on the damage of liver function. UTI treatment can inhibit the increase of TBIL, ALT, AST, ET and so on.