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目的 :了解急性重症胰腺炎患者血浆内皮素、一氧化氮、血栓素A2 和前列环素变化与肝损害的关系。方法 :采用放射免疫法动态检测血浆总内皮素、血栓素A2 和前列环素的稳定代谢产物血栓素B2 与6 酮 前列腺素F1α及采用反相高效液相色谱法检测一氧化氮的稳定代谢产物硝酸盐和亚硝酸盐。结果 :治疗前血浆总内皮素和内皮素 /一氧化氮比值均增高 ,治疗后 3天时内皮素 /一氧化氮比值更高 ,以后逐渐降至正常 ;血栓素A2 和血栓素A2 /前列环素比值的变化规律与内皮素的相似 ;血清总胆红素、谷氨酶丙酮酸转氨酶及乳酸脱氢酶的变化规律与内皮素 /一氧化氮比值的一致。结论 :急性重症胰腺炎时内皮素及内皮素 /一氧化氮比值和血栓素A2 及血栓素A2 /前列环素比值增高可能是导致肝损害的重要原因 ,其机制可能是引起或加重肝脏微循环障碍。
Objective: To investigate the relationship between plasma endothelin, nitric oxide, thromboxane A2 and prostacyclin in patients with acute severe pancreatitis and liver damage. Methods: Radioimmunoassay was used to detect thromboxane B2 and 6-ketoprostaglandin F1α, the stable metabolites of total endothelin, thromboxane A2 and prostacyclin, and to detect the steady-state metabolites of nitric oxide by reversed-phase high performance liquid chromatography Nitrate and nitrite. Results: Before treatment, the ratio of total endothelin and endothelin / nitric oxide increased. After 3 days of treatment, the ratio of endothelin / nitric oxide was higher and then gradually decreased to normal. Thromboxane A2 and thromboxane A2 / prostacyclin The change of ratio was similar to that of endothelin. The changes of serum total bilirubin, glutaminase pyruvate transaminase and lactate dehydrogenase were in accordance with the ratio of endothelin / nitric oxide. Conclusion: In acute severe acute pancreatitis, the ratio of endothelin and endothelin / nitric oxide and the ratio of thromboxane A2 and thromboxane A2 / prostacyclin may play an important role in the pathogenesis of hepatic injury. The mechanism may be to cause or aggravate liver microcirculation obstacle.