CAJ | 학술논문

目的：探讨分阶段联合介入术治疗门静脉高压症并发食管静脉曲张出血和脾功能亢进的临床疗效及对Rho-ROCK 表达的影响。方法采用分阶段联合介入术（PTVE＋PSE）治疗53例肝硬化门脉高压症并发食管静脉曲张出血和脾功能亢进患者，分析治疗前后血常规、肝功能等。实时 PCR 检测分阶段联合介入术前后 PBMC 中 Rho、ROCK1和ROCK2的表达，Western 印迹观察分阶段联合介入术前后 PBMC 中 Rho、ROCK1、ROCK2、磷酸化肌球蛋白磷酸酶1（p MYPT1）及总 MYPT1（tMYPT1）蛋白表达情况。结果术后急诊止血率达100％；术后曲张静脉消失、WBC、PLT 明显上升，治疗后1、4、6个月与治疗前相比，均明显好转（P＜0．05）；术后 Alb 明显上升，TBil、INR 下降，与治疗前相比，明显好转（P＜0．05）。术后无严重并发症。术前及术后，Rho、ROCK1、ROCK2 mRNA 表达均高于正常对照组（P＜0．01），术后组的 Rho、ROCK1、ROCK2 mRNA 表达明显低于术前组（P＜0．01）。术后组 Rho、ROCK1、ROCK2、p MYPT1蛋白表达较术前明显下调。结论分阶段联合介入术能有效治疗食管静脉曲张出血、脾功能亢进及改善肝功能，其疗效可能与影响调控 Rho-ROCK 信号通路相关。
목적：탐토분계단연합개입술치료문정맥고압증병발식관정맥곡장출혈화비공능항진적림상료효급대Rho-ROCK 표체적영향。방법채용분계단연합개입술（PTVE＋PSE）치료53례간경화문맥고압증병발식관정맥곡장출혈화비공능항진환자，분석치료전후혈상규、간공능등。실시 PCR 검측분계단연합개입술전후 PBMC 중 Rho、ROCK1화ROCK2적표체，Western 인적관찰분계단연합개입술전후 PBMC 중 Rho、ROCK1、ROCK2、린산화기구단백린산매1（p MYPT1）급총 MYPT1（tMYPT1）단백표체정황。결과술후급진지혈솔체100％；술후곡장정맥소실、WBC、PLT 명현상승，치료후1、4、6개월여치료전상비，균명현호전（P＜0．05）；술후 Alb 명현상승，TBil、INR 하강，여치료전상비，명현호전（P＜0．05）。술후무엄중병발증。술전급술후，Rho、ROCK1、ROCK2 mRNA 표체균고우정상대조조（P＜0．01），술후조적 Rho、ROCK1、ROCK2 mRNA 표체명현저우술전조（P＜0．01）。술후조 Rho、ROCK1、ROCK2、p MYPT1단백표체교술전명현하조。결론분계단연합개입술능유효치료식관정맥곡장출혈、비공능항진급개선간공능，기료효가능여영향조공 Rho-ROCK 신호통로상관。
Objective To investigate the clinical efficacy and Rho/ROCK expression of patients treated with phased joint intervention,which with portal hypertension complicated by esophageal variceal bleeding and hypersplenism.Methods Fifty-three patients with portal hypertension caused by liver cirrhosis and complicated by esophageal variceal bleeding and hypersplenism were reviewed.All of the patients were treated with percutaneous transhepatic variceal embolization (PTVE)plus transcatheter splenic arterial embolization (PSE).Blood routine,liver function,etc,were analyzed.Peri-pheral blood mononuclear cells (PBMCs)were separated and prepared;Rho,ROCK1 and ROCK2 expression levels were tested by real time PCR in PBMCs before and after phased joint intervention;Western Blot was applied for observing protein expression of Rho,ROCK1 ,ROCK2,phosphorylated MYPT1 (p MYPT1 )and total MYPT1 (t MYPT1 )from PBMC before and after phased joint intervention.Results There were 53 cases of emergency hemostasis and emergency hemostasis rate was 100%,and varicose veins disappeared after operation.There was a significant increase in levels of white blood cells and platelets after operative,which was improved markedly (P<0.05 )1 ,4 and 6 months after treatment,respectively. Higher albumin and lower total bilirubin and INR were observed after intervention,and these parameters were improved significantly (P<0.05)1 ,4 and 6 months after treatment.No serious postoperative complications were found.Preopera-tive and postoperative expression levels of Rho,ROCK1 and ROCK2 mRNA were higher than those of normal control group (P<0.01).Expression levels of Rho,ROCK1 and ROCK2 mRNA of postoperative group were significantly lower than those of preoperative group (P< 0.01 ).Compared to preoperative group,protein expression levels of Rho,ROCK1 , ROCK2 and pMYPT1 of postoperative group reduced obviously.Conclusion Phased joint intervention can effectively treat esophageal variceal bleeding and hypersplenism,and improve liver function,of which efficacy may be associated with the signaling pathways of regulating Rho-ROCK.