丹参预处理对肝脏缺血再灌注后胃肠激素的影响
단삼예처리대간장결혈재관주후위장격소적영향
Changes of gastrointestinal hormones before and after hepatic ischemia reperfusion and the role of salvia miltiorrhiza pretreatment
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    CHINESE JOURNAL OF DIGESTIVE SURGERY
    2014年 3期 213-217 ,共5页

    张智勇%卢绮萍%陈孝平

    장지용%로기평%진효평

    肝脏%缺血再灌注%胃肠激素%丹参 肝髒%缺血再灌註%胃腸激素%丹參
    간장%결혈재관주%위장격소%단삼
    Liver%Ischemia reperfusion%Gastrointesitnal hormones%Salvia miltiorrhiza
    目的 探讨丹参预处理对肝脏缺血再灌注后胃肠激素的影响.方法 前瞻性研究2010年5月至2012年5月广州军区武汉总医院收治的32例肝病患者,对所有患者行肝部分切除术,术中行第一肝门阻断.按随机数字表法将32例患者分为2组:缺血再灌注组(IR组,15例)和丹参预处理组(SM组,17例),两组患者均在术中行肝部分切除,以Pringle法行第一肝门阻断约15 ～ 20 min,IR组术前3d给予30 mL/d生理盐水静脉滴注,SM组术前3d给予丹参注射液30 mL/d静脉滴注;12例开腹手术而未行肝门阻断者作为阴性对照组(SO组);5例健康志愿者作为正常对照组(CO组).分别测定各组胃动素、胆囊收缩素、血管活性肠肽、胰泌素水平变化情况.多组比较采用单因素方差分析,两两比较采用LSD-t检验.结果 CO组胃动素水平为(347±14) μg/L,SO组术后24、48、72 h胃动素水平分别为(324±13) μg/L、(345±12) μg/L和(345±13) μg/L,IR组分别为(307±10) μg/L、(316±9)μg/L和(338±13) μg/L,SM组分别为(313±7) μg/L、(337±12) μg/L和(345±12)μg/L.SO组术后24 h胃动素水平显著低于CO组(t =5.25,P＜0.05);IR组术后24、48、72 h胃动素水平显著低于同时相点SO组(t=10.05,8.09,2.07,P＜0.05);SM组胃动素表达水平在术后24、48 h显著低于SO组(t=9.83,2.28,P＜0.05),但是至术后72 h与SO组比较,差异无统计学意义(t=0.36,P＞O.05);SM组胃动素表达水平在术后24、48、72 h显著高于IR组(=3.80,7.10,2.35,P＜0.05).CO组胆囊收缩素水平为(2.53±0.06) μg/L,SO组24、48、72 h胆囊收缩素水平分别为(3.28±0.09) μg/L、(2.52±0.09) μg/L和(2.54±0.16) μg/L,IR组分别为(4.34±0.21)μg/L、(3.63±0.31) μg/L和(3.25±0.09)μg/L,SM组分别为(3.71±0.28) μg/L、(3.28±0.11)μg/L和(2.53±0.09) μg/L.SO组术后24h胆囊收缩素水平显著高于CO组(t=4.33,P＜0.05);IR组术后24、48、72 h胆囊收缩素水平显著高于同时相点的SO组(t=9.32,5.37,2.16,P＜0.05);SM组胆囊收缩素表达水平在术后24、48 h显著高于SO组(t=7.21,3.42,P＜0.05),但是至术后72 h与SO组比较,差异无统计学意义(t =0.29,P＞0.05).SM组胆囊收缩素表达水平在术后24、48、72 h显著低于IR组(t=5.62,4.63,3.57,P＜0.05).CO组血管活性肠肽水平为(11.8±1.6)μg/L,SO组术后24、48、72 h血管活性肠肽水平分别为(21.5±3.8) μg/L、(12.2±1.6)μg/L和(11.9±1.7)μg/L,IR组分别为(29.7±4.1) μg/L、(22.9±4.2) μg/L和(18.8±2.8) μg/L,SM组分别为(22.4±4.1)μg/L、(16.4±2.3) μg/L和(12.1±1.6) μg/L.SO组术后24 h血管活性肠肽水平显著高于CO组(t=3.59,P＜0.05);IR组患者血管活性肠肽表达水平在术后24、48、72 h显著高于同时相点SO组(t=6.35,3.22,2.36,P＜0.05).SM组患者血管活性肠肽表达水平在术后24、48 h显著高于SO组(t=5.04,2.33,P＜0.05),但是至术后72 h与SO组比较,差异无统计学意义(t =0.18,P＞0.05).SM组患者血管活性肠肽表达水平在术后24、48、72 h显著低于IR组(t=4.27,3.87,2.45,P＜0.05).CO组胰泌素水平为(75±5)μg/L,SO组术后24、48、72 h胰泌素水平分别为(98±6)μg/L、(76±4) μ.g/L和(76±4) μg/L,IR组分别为(129±6) μg/L、(102±8)μ.g/L和(89±6) μg/L,SM组分别为(104±8)μg/L、(90±6) μg/L和(74±4) μg/L.SO组术后24h胰泌素水平显著高于CO组(=3.27,P＜0.05);IR组患者胰泌素表达水平在术后24、48、72 h显著高于同时相点SO组(=5.20,2.94,1.77,P＜0.05).SM组患者胰泌素表达水平在术后24、48 h显著高于SO组(t=4.16,2.54,P＜0.05),但是至术后72 h与SO组比较,差异无统计学意义(=0.23,P＞0.05).SM组患者胰泌素表达水平在术后24、48、72 h显著低于IR组(t=5.13,4.32,2.87,P＜0.05).结论 肝门阻断所致胃肠道淤血可导致同期胃动素表达下调,胆囊收缩素、血管活性肠肽、胰泌素表达上升;丹参可能通过改善微循环、减轻胃肠道水肿,改善胃肠运动功能,间接影响胃肠激素的分泌表达.
    목적 탐토단삼예처리대간장결혈재관주후위장격소적영향.방법 전첨성연구2010년5월지2012년5월엄주군구무한총의원수치적32례간병환자,대소유환자행간부분절제술,술중행제일간문조단.안수궤수자표법장32례환자분위2조:결혈재관주조(IR조,15례)화단삼예처리조(SM조,17례),량조환자균재술중행간부분절제,이Pringle법행제일간문조단약15 ～ 20 min,IR조술전3d급여30 mL/d생리염수정맥적주,SM조술전3d급여단삼주사액30 mL/d정맥적주;12례개복수술이미행간문조단자작위음성대조조(SO조);5례건강지원자작위정상대조조(CO조).분별측정각조위동소、담낭수축소、혈관활성장태、이비소수평변화정황.다조비교채용단인소방차분석,량량비교채용LSD-t검험.결과 CO조위동소수평위(347±14) μg/L,SO조술후24、48、72 h위동소수평분별위(324±13) μg/L、(345±12) μg/L화(345±13) μg/L,IR조분별위(307±10) μg/L、(316±9)μg/L화(338±13) μg/L,SM조분별위(313±7) μg/L、(337±12) μg/L화(345±12)μg/L.SO조술후24 h위동소수평현저저우CO조(t =5.25,P＜0.05);IR조술후24、48、72 h위동소수평현저저우동시상점SO조(t=10.05,8.09,2.07,P＜0.05);SM조위동소표체수평재술후24、48 h현저저우SO조(t=9.83,2.28,P＜0.05),단시지술후72 h여SO조비교,차이무통계학의의(t=0.36,P＞O.05);SM조위동소표체수평재술후24、48、72 h현저고우IR조(=3.80,7.10,2.35,P＜0.05).CO조담낭수축소수평위(2.53±0.06) μg/L,SO조24、48、72 h담낭수축소수평분별위(3.28±0.09) μg/L、(2.52±0.09) μg/L화(2.54±0.16) μg/L,IR조분별위(4.34±0.21)μg/L、(3.63±0.31) μg/L화(3.25±0.09)μg/L,SM조분별위(3.71±0.28) μg/L、(3.28±0.11)μg/L화(2.53±0.09) μg/L.SO조술후24h담낭수축소수평현저고우CO조(t=4.33,P＜0.05);IR조술후24、48、72 h담낭수축소수평현저고우동시상점적SO조(t=9.32,5.37,2.16,P＜0.05);SM조담낭수축소표체수평재술후24、48 h현저고우SO조(t=7.21,3.42,P＜0.05),단시지술후72 h여SO조비교,차이무통계학의의(t =0.29,P＞0.05).SM조담낭수축소표체수평재술후24、48、72 h현저저우IR조(t=5.62,4.63,3.57,P＜0.05).CO조혈관활성장태수평위(11.8±1.6)μg/L,SO조술후24、48、72 h혈관활성장태수평분별위(21.5±3.8) μg/L、(12.2±1.6)μg/L화(11.9±1.7)μg/L,IR조분별위(29.7±4.1) μg/L、(22.9±4.2) μg/L화(18.8±2.8) μg/L,SM조분별위(22.4±4.1)μg/L、(16.4±2.3) μg/L화(12.1±1.6) μg/L.SO조술후24 h혈관활성장태수평현저고우CO조(t=3.59,P＜0.05);IR조환자혈관활성장태표체수평재술후24、48、72 h현저고우동시상점SO조(t=6.35,3.22,2.36,P＜0.05).SM조환자혈관활성장태표체수평재술후24、48 h현저고우SO조(t=5.04,2.33,P＜0.05),단시지술후72 h여SO조비교,차이무통계학의의(t =0.18,P＞0.05).SM조환자혈관활성장태표체수평재술후24、48、72 h현저저우IR조(t=4.27,3.87,2.45,P＜0.05).CO조이비소수평위(75±5)μg/L,SO조술후24、48、72 h이비소수평분별위(98±6)μg/L、(76±4) μ.g/L화(76±4) μg/L,IR조분별위(129±6) μg/L、(102±8)μ.g/L화(89±6) μg/L,SM조분별위(104±8)μg/L、(90±6) μg/L화(74±4) μg/L.SO조술후24h이비소수평현저고우CO조(=3.27,P＜0.05);IR조환자이비소표체수평재술후24、48、72 h현저고우동시상점SO조(=5.20,2.94,1.77,P＜0.05).SM조환자이비소표체수평재술후24、48 h현저고우SO조(t=4.16,2.54,P＜0.05),단시지술후72 h여SO조비교,차이무통계학의의(=0.23,P＞0.05).SM조환자이비소표체수평재술후24、48、72 h현저저우IR조(t=5.13,4.32,2.87,P＜0.05).결론 간문조단소치위장도어혈가도치동기위동소표체하조,담낭수축소、혈관활성장태、이비소표체상승;단삼가능통과개선미순배、감경위장도수종,개선위장운동공능,간접영향위장격소적분비표체.
    Objective To study the changes of gastrointestinal hormones before and after hepatic ischemia reperfusion and the role of salvia miltiorrhiza pretreatment.Methods The clinical data of 32 patients with hepatic diseases who were admitted to the Wuhan General Hospital of Guangzhou Military Area of PLA from May 2010 to May 2012 were prospectively analyzed.Thirty-two patients with hepatic inflow occlusion were randomly divided into the ischemia reperfusion group (IR group,15 patients) and salvia miltiorrhiza pretreatment group (SM group,17 patients).Patients in the IR group and SM group received partial hepatectomy with hepatic inflow occlusion by Pringle maneuver for 15-20 minutes.Patients in the IR group and SM group were injected with normal saline and salvia miltiorrhiza (30 mL/d) by intravenous drip for 3 days before operation,respectively.Twelve patients with hepatic diseases who received open surgery without block of hepatic inflow occlusion were enrolled in the negative control group (SO group) and 5 healthy volunteers were enrolled in the normal control group (CO group).The changes of the motilin,cholecystokinin,vasoactive intestinal peptide and secretin of the 4 groups were recorded.All data were analyzed using the analysis of variance or LSD-t test.Results The level of motilin of the CO group was (347 ± 14)μg/L.The levels of motilin of the SO group,IR group,and SM group at postoperative 24,48 and 72 hours were (324 ± 13) μg/L,(345 ± 12)μg/L,(345 ± 13)μg/L,(307 ± 10)μg/L,(316 ±9)μg/L,(338 ±13) μg/L,(313 ± 7) μg/L,(337 ± 12) μg/L and (345 ± 12) μg/L,respectively.The level of motilin of the SO group at postoperative 24 hours was significantly lower than that of the CO group (t =5.25,P ＜ 0.05) ; the levels of motilin of the IR group at postoperative 24,48 and 72 hours were significantly lower than those of the SO group (t =10.05,8.09,2.07,P ＜0.05) ; the levels of motilin of the SM group at postoperative 24 and 48 hours were significantly lower than those of the SO group (t =9.83,2.28,P ＜ 0.05),while there was no significant difference in the level of motilin between the SM group and the SO group at postoperative 72 hours (t =0.36,P ＞0.05) ;the levels of motilin of the SM group at postoperative 24,48 and 72 hours were significantly higher than those of the IR group (t =3.80,7.10,2.35,P＜0.05).The levels of cholecystokinin of the CO group was (2.53±0.06)μg/L.The levels of cholecystokinin of the SO group,IR group and SM group at postoperative 24 hours were (3.28 ±0.09) μg/L,(2.52 ±0.09) μg/L,(2.54 ±0.16)μg/L,(4.34 ±0.21) μg/L,(3.63 ±0.31)μg/L,(3.25 ± 0.09) μg/L,(3.71 ±0.28)μg/L,(3.28±0.11)μg/L and (2.53 ±0.09)μg/L,respectively.The level of cholecystokinin of the SO group at postoperative 24 hours was significantly higher than that of the CO group (t =4.33,P ＜ 0.05) ; the levels of cholecystokinin of the IR group at postoperative 24,48and 72 hours were significantly higher than those of the SO group (t =9.32,5.37,2.16,P＜0.05) ; the levels of cholecystokinin of the SM group at postoperative 24 and 48 hours were significantly higher than those of the SO group (t =7.21,3.42,P ＜ 0.05),while there was no significant difference in the level of cholecystokinin between the SM group and the SO group at postoperative 72 hours (t =0.29,P ＞ 0.05) ; the levels of cholecystokinin of the SM group at postoperative 24,48 and 72 hours were significantly higher than those of the IR group (t =5.62,4.63,3.57,P ＜ 0.05).The level of vasoactive intestinal peptide of the CO group was (11.8 ±1.6) tμg/L.The levels of vasoactive intestinal peptide of the SO group,IR group,and SM group at postoperative 24,48 and 72 hours were (21.5 ± 3.8) μg/L,(12.2 ± 1.6) μg/L,(11.9 ± 1.7) μg,/L,(29.7 ± 4.1) μg/L,(22.9±4.2)μg/L,(18.8±2.8)μg/L,(22.4 ±4.1)μg/L,(16.4±2.3)μg/L and (12.1 ±1.6)μg/L,respectively.The level of vasoactive intestinal peptide of the SO group at postoperative 24 hours was significantly higher than that of the CO group (t =3.59,P ＜ 0.05) ; the levels of vasoactive intestinal peptide of the IR group at postoperative 24,48 and 72 hours were significantly higher than those of the SO group (t =6.35,3.22,2.36,P ＜ 0.05) ; the levels of vasoactive intestinal peptide of the SM group at postoperative 24 and 48 hours were significantly higher than those of the SO group (t =5.04,2.33,P ＜ 0.05),while there was no significant difference in the level of vasoactive intestinal peptide between the SM group and the SO group at postoperative 72 hours (t =0.18,P ＞ 0.05) ;the levels of vasoactive intestinal peptide of the SM group at postoperative 24,48and 72 hours were significantly lower than those of the IR group (t =4.27,3.87,2.45,P ＜ 0.05).The level of secretin of the CO group was (75 ± 5) μg/L.The levels of secretin of the SO group,IR group and SM group at postoperative 24,48 and 72 hours were (98 ± 6) μg/L,(76 ± 4) μg/L,(76 ± 4) μg/L,(129 ± 6) μg/L,(102 ±8) μg/L,(89 ± 6) μg/L,(104 ± 8) μg/L,(90 ± 6) μg/L and (74 ± 4) μg/L,respectively.The level of secretin of the SO group at postoperative 24 hours was significantly higher than that of the CO group (t =3.27,P ＜ 0.05) ;the levels of secretin of the IR group at postoperative 24,48 and 72 hours were significantly higher than those of the SO group (t =5.20,2.94,1.77,P ＜ 0.05) ; the level of secretin of SM group at postoperative 24 and 48 hours were significantly higher than those of the SO group (t =4.16,2.54,P＜0.05),while there was no significant difference in the level of secretin between the SM group and the SO group at postoperative 72 hours (t =0.23,P ＞ 0.05) ; the levels of secretin of the SM group at postoperative 24,48 and 72 hours were significantly lower than those of the IR group (t =5.13,4.32,2.87,P ＜ 0.05).Conclusions Gastrointestinal congestion caused by hepatic blocking leads to the decline of the expression of motilin,but the increase of the expression of cholecystokinin,vasoactive intestinal peptide,secretin.Salvia miltiorrhiza may improve micro-circulation,abate gastrointestinal adema,and influence the gastrointestinal hormone expression in an indirect way.
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