CAJ | 학술논문

目的：探讨前列腺素E1（PGE1）对肝切除术后肝功能的保护作用及机制。方法选取118例接受肝大部切除术患者，其中A组36例（术后常规治疗），B组40例（术后常规治疗+PGE120μg/d，静脉注射，连续14d），C组42例（术中门静脉阻断再开放时行Lipo- PGE120μg门静脉灌注+B组方案）。分别检测3组患者术前与术后1、3、5、9、14、28d外周血ALT及TNF-α、IL-6、IL-10、IFN-γ水平，以及术前与术后1、7、28d门静脉血流量的变化。结果3组患者术前各指标差异均无统计学意义（均P＞0.05）。术后各组患者ALT、TNF-α、IL-6、IL-10水平均明显升高，然后逐渐恢复，但B、C组升高幅度明显低于A组（均P＜0.01），且恢复时间快于A组；A组IFN-γ水平在手术前后无明显改变，但B、C组在术后28d，IFN-γ水平明显持续升高（均P＜0.01）。A组门静脉血流量手术前后无明显改变，而B、C组术后门静脉血流量在观察时段内明显且逐渐增高（均P＜0.05）。以上所有PGE1干预引起的变化，C组均较B组明显。结论 PGE1有利于肝切除术后早期功能的恢复，其作用机制可能与调节细胞因子水平及增加门静脉血流有关。
목적：탐토전렬선소E1（PGE1）대간절제술후간공능적보호작용급궤제。방법선취118례접수간대부절제술환자，기중A조36례（술후상규치료），B조40례（술후상규치료+PGE120μg/d，정맥주사，련속14d），C조42례（술중문정맥조단재개방시행Lipo- PGE120μg문정맥관주+B조방안）。분별검측3조환자술전여술후1、3、5、9、14、28d외주혈ALT급TNF-α、IL-6、IL-10、IFN-γ수평，이급술전여술후1、7、28d문정맥혈류량적변화。결과3조환자술전각지표차이균무통계학의의（균P＞0.05）。술후각조환자ALT、TNF-α、IL-6、IL-10수평균명현승고，연후축점회복，단B、C조승고폭도명현저우A조（균P＜0.01），차회복시간쾌우A조；A조IFN-γ수평재수술전후무명현개변，단B、C조재술후28d，IFN-γ수평명현지속승고（균P＜0.01）。A조문정맥혈류량수술전후무명현개변，이B、C조술후문정맥혈류량재관찰시단내명현차축점증고（균P＜0.05）。이상소유PGE1간예인기적변화，C조균교B조명현。결론 PGE1유리우간절제술후조기공능적회복，기작용궤제가능여조절세포인자수평급증가문정맥혈류유관。
Objective To investigate the protective effect of prostaglandin E1 (PGE1) on liver function in patients after hep-atectomy. Methods One hundred and eighteen patients scheduled to undergo major liver resection were randomly designated to group A(receiving conventional postoperative treatment n=36), group B (receiving conventional treatment plus intravenous in-jection of 20μg/d Lipo- PGE1 for 14d, n=40) and group C (undergoing portal vein infusion of 20μg Lipo- PGE1 immediately after portal vein clamping was finished during surgery plus the same regimen as group B, n=42). The levels of alanine transaminase (ALT) and cytokines TNF- α, IL- 6, IL- 10 and IFN- γin peripheral blood were measured before and 1, 3, 5, 9, 14 and 28 d after surgery, and the portal venous flow volume was also determined before and 1, 7 and 24 d after surgery. Results Al parameters among the three groups had no significant differences before surgery (al P>0.05). The levels of TNF- α, IL- 6 and IL- 10 in all groups were markedly increased after surgery and then returned to baseline gradual y, while these cytokines in groups B and C were increased significantly less and decreased shorter than those in group A (al P<0.05). The pre- and postoperative IFN- γlevels in group A showed no significant changes, but those in groups B and C were significantly increased and continued to rise until 28 d after surgery (al P<0.05).No difference was observed in portal venous flow volume before and after surgery in group A, while a continuous increase was found after surgery in groups B and C (al P<0.05). All the changes caused by PGE1 intervention were more evident in group C than those in group B. Conclusion PGE1 is beneficial for early recovery of liver function after hep-atectomy, which may be related to regulating cytokines levels and increasing the portal venous inflow.