TIPS治疗前后肝硬化门静脉高压患者血清CXCL9、 TXA2 和PGI2 水平及其与预后的相关性研究

Changes in serum levels of CXCL9, TXA2 and PGI2 before and after TIPS for liver cirrhosis with portal hypertension and their correlation with prognosis

摘要:

目的 研究经颈静脉肝内门体分流术（TIPS）治疗肝硬化门静脉高压前后血清CXCL9、血栓 素A2（TXA2）、前列腺素I2（PGI2）水平变化及其与预后的相关性。方法 选取2013 年1 月—2014 年12 月 青海大学附属医院行TIPS 治疗的75 例乙肝肝硬化门静脉高压患者作为研究对象。中位生存时间910 d，其 中≥ 910 d 35 例，<910 d 40 例。记录患者手术前后肝功能指标、门静脉压力、门静脉血流指数及血清CXCL9、 TXA2、PGI2 水平；并以中位生存时间分组，比较生存时间≥ 910 d 与<910 d 患者血清CXCL9、TXA2、PGI2 水平，Spearman 相关性分析上述指标与预后的相关性。结果 术后2 周患者谷丙转氨酶（ALT）、谷草转氨 酶（AST）较术前下降，白蛋白（ALB）上升（P <0.05）；术后1 周患者门静脉压力、门静脉血流指数、血清 CXCL9、TXA2、PGI2 水平比术前下降（P <0.05）；生存时间≥ 910 d 患者术前血清CXCL9、TXA2、PGI2 水 平分别为（290.95±83.51）pg/ml、（89.12±16.35）ng/L、（121.93±29.56）ng/L，均低于生存时间<910 d 患 者的（340.12±96.59）pg/ml、（121.26±23.08）ng/L、（159.83±32.65）ng/L（P <0.05）；Spearman 相关性分 析显示术前血清CXCL9、TXA2、PGI2 水平与患者预后呈负相关（P <0.05）。结论 TIPS 治疗能改善肝硬化 门静脉高压患者肝功能，降低门静脉压力，术后血清CXCL9、TXA2 及PGI2 水平下降；术前血清CXCL9、 TXA2 及PGI2 水平与患者预后密切相关。

Abstract:

Objective To study the changes in serum levels of CXCL9, thromboxane A2 (TXA2) and prostacyclin (PGI2) before and after transjugular intrahepatic portosystemic shunt (TIPS) for liver cirrhosis with portal hypertension, and their correlation with the prognosis. Methods Totally 75 patients with liver cirrhosis and portal hypertension who were treated by TIPS in the hospital from January 2013 to December 2014 were selected as the subjects. The median survival time was 910 days. Survival time of 35 cases was longer than or equal to 910 days and that of the other 40 cases was shorter than 910 days. The liver function indexes, portal pressure, portal blood flow index and the levels of serum CXCL9, TXA2 and PGI2 were recorded before and after operation. According to the median survival time, the patients were grouped. Serum levels of CXCL9, TXA2 and PGI2 were compared between the survival time ≥ 910 d group and the survival time < 910 d group. The correlation between the above indexes and the prognosis was analyzed by Spearman correlation analysis. Results The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) decreased and albumin (ALB) increased 2 weeks after operation (P < 0.05). The portal pressure, portal blood flow index and serum levels of CXCL9, TXA2 and PGI2 decreased 1 week after operation (P < 0.05). Serum levels of CXCL9, TXA2 and PGI2 in the survival time ≥ 910 d group [(290.95 ± 83.51) pg/ml, (89.12 ± 16.35) ng/L, (121.93 ± 29.56) ng/L] were lower than those in the survival time < 910 d group [(340.12 ± 96.59) pg/ml, (121.26 ± 23.08) ng/L, (159.83 ± 32.65) ng/L] (P < 0.05). Spearman correlation analysis showed that the preoperative serum levels of CXCL9, TXA2 and PGI2 were negatively correlated with the prognosis of patients (P < 0.05). Conclusions TIPS can improve the liver function and decrease the portal pressure in patients with liver cirrhosis and portal hypertension. After operation, serum levels of CXCL9, TXA2 and PGI2 decrease. Preoperative serum levels of CXCL9, TXA2 and PGI2 are closely related to the prognosis.