| 穆兰英,牟玉珍,雷振武.部分脾栓塞术治疗肝硬化伴脾功能亢进的临床效果及对血流动力学和炎症水平的影响:一项随机、对照、开放研究[J].安徽医药,2020,24(9):1735-1739. |
| 部分脾栓塞术治疗肝硬化伴脾功能亢进的临床效果及对血流动力学和炎症水平的影响:一项随机、对照、开放研究 |
| Clinical effect of partial splenic embolization on liver cirrhosis with hypersplenism and its influence on hemodynamic and inflammation:a randomized，controlled，open-label study |
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| DOI：10.3969/j.issn.1009-6469.2020.09.010 |
| 中文关键词: 肝硬化 脾功能亢进 栓塞，治疗性 门脉系统 部分脾栓塞术 血流动力学 炎症 |
| 英文关键词: Liver cirrhosis Hypersplenism Embolization,therapeutic Portal system Partial splenic embolization(PSE) Hemodynamics Inflammation |
| 基金项目:青海省卫生计生委重点课题( 2018-wjzd-13) |
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| 中文摘要: |
| 目的探究部分脾栓塞术( PSE)治疗肝硬化伴脾功能亢进(简称“脾亢”)的临床效果及对血流动力学和炎症水平的影响。方法选取 2017年 3月至 2018年 8月青海大学附属医院收治的 96例肝硬化伴脾亢病人作为研究对象，按照随机数字表法分成对照组与观察组，各 48例。对照组行脾切除术，观察组行 PSE。对两组病人进行 6个月的随访观察，比较两组病人的血常规指标、并发症发生情况、门静脉血流动力学指标及炎症水平。结果两组病人在术后 3d、术后 1个月和术后 6个月时的白细胞、红细胞、血小板数量均较术前升高( P＜0.05)；与对照组相比，观察组病人在 4个时间点的白细胞、红细胞数量以及在术前、术后 3d、术后 1个月时的血小板数量差异无统计学意义( P＞0.05)而在术后 6个月时的血小板数量［(134.49±40.75)×109/L比( 196.30±39.66)×109/L］降低( P＜0.05)。与对照组相比较，观察组在腹，痛( 19例比 34例)和血栓形成( 2例比 8例)的发生率降低( P＜0.05)。两组病人在术后 3d、术后 1个月和术后 6个月时的门静脉内径、门静脉流速、门脉压力均较术前降低(P＜0.05)；与对照组相比较，观察组病人在术后 1个月时的门静脉流速［(14.82±1.60)cm/s比( 16.05±1.73)cm/s］、门脉压力［(30.29±2.81) cmH2O比( 34.50±3.16)cmH2O］降低( P＜0.05)。两组病人在术后 3d、术后 1个月和术后 6个月时的肿瘤坏死因子 α(TNF-α)、白细胞介素 6(IL-6)含量均较术前降低( P＜0.05)；与对照组相比较，观察组在术后 3个时间点的 TNF-α含量［术后 3d(20.52± 3.70)ng/L比( 27.38±4.66)ng/L，术后 1个月( 14.82±4.05)ng/L比( 23.55±4.13)ng/L，术后 6个月( 10.09±3.14)ng/L比( 19.43±3.72) ng/L］以及术后 3d、术后 1个月时的 IL-6含量［术后 3d(35.17±5.21)ng/L比( 44.69±5.78)ng/L，术后 1个月( 24.63±4.85)ng/L比(36.99±5.20)ng/L］降低( P＜0.05)，而白细胞介素 10(IL-10)含量差异无统计学意义( P＞0.05)。结论 PSE治疗肝硬化伴脾亢具有较好的临床效果，可以降低并发症的发生，改善门静脉血流，下调炎症水平。 |
| 英文摘要: |
| Objective To explore the clinical effect of partial splenic embolization(PSE)on liver cirrhosis with hypersplenism and its influence on hemodynamic and inflammation.Methods Ninety-six liver cirrhosis patients with hypersplenism who were admit-ted to Affiliated Hospital of Qinghai University from March 2017 to August 2018were selected as the study subjects，and randomly divided into control group and observation group by random number table method，48 cases in each.Splenectomy was performed inthe control group and PSE was performed in the observation group.Patients in the two groups were followed up for 6 months.Theblood routine parameters，complications，hemodynamic of portal vein and inflammation levels were compared between the two groups.Results The number of white blood cells，red blood cells and platelets in the two groups at 3 days，1 month and 6 months after operation were all higher than those before operation(P＜0.05).Compared with the control group，there was no statistically significant difference in the number of white blood cells，red blood cells at 4 time points，and plateletsbefore，3 days and 1 month after operation in the observation group(P＞0.05)，but the number of platelets［(134.49±40.75)×109/L vs.(196.30±39.66)×109/L］ decreased at 6 months after operation(P＜0.05).Compared with the control group，the incidence of abdominal pain(19 cases vs.34 cases)and thrombosis(2 cases vs. 8 cases)in the observation group decreased(P＜0.05).The diameter，velocity and pressure of portal vein in the two groups at 3 days，1 month and 6 months after operation were all lower than those before operation(P＜0.05).Compared with the control group，the velocity［( 14.82±1.60)cm/s vs.(16.05±1.73)cm/s］and pressure［( 30.29±2.81)cmH2O vs.(34.50±3.16)cmH2O］of portal vein in the observation group decreased at 1 month after operation(P＜0.05).The levels of tu- mor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the two groups at 3 days，1 month and 6 months after operation were all lower than those before operation(P＜0.05).Compared with the control group，the levels of TNF-α［3 d after operation(20.52±3.70)ng/L vs.(27.38±4.66)ng/L，1 month after operation(14.82±4.05ng/L vs.(23.55±4.13)ng/L，6 months after operation(10.09±3.14)ng/L vs.(19.43±3.72)ng/L］in the observation group decreased at 3 time points after operation，and the levels of IL-6［3 d after operation(35.17±5.21)ng/L vs.(44.69±5.78)ng/L，1 month after operation(24.63±4.85)ng/L vs.(36.99±5.20)ng/L］decreased at 3 days and 1 month after operation(P＜0.05)，while there was no statistically significant difference in the content of interleukin-10(IL-10)( P＞0.05).Conclusion PSE has a good clinical effect in the treatment of liver cirrhosis with hypersplenism.It can reduce the occurrence of complications，improve blood flow of portal vein and reduce the inflammation level. |
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