Epression And Clinical Significance Of VEGF And TIMP-1 In The Liver Of Patient With Budd-Chiari Syndrome

Background and Objective: Budd-Chiari syndrome (B-CS) is a severe disease which harm the health of people seariously, the nature prognosis is very poor. It presents the outlet obstruction of major hepatic veins (MHVs) and/or retrohepatic inferior vena cava (IVC) which results in portal hypertension (PHT) and/or IVC hypertension syndrome. Since Budd described this desease firstly in 1845, almost 170 years had past, thanks to the development of the medical technology in the past decade, a large amount of cases were diagnosed and reported. The incidence of B-CS is about 4-6 per 100,000 in China. Most of the cases distributed in Northern privinces, such as henan, Anhui, Shandong and Hebei etc.XuPeiqin et al. had treated more than 1500 cases since 1983 in the General Surgery Department of the First Affiliated Hospital of Zhengzhou University.They concluded the proper clinical typing of B-CS and correspondent treatment methods. Budd-Chiari syndrome is a kind of retrohepatic hypertension.The patients with B-CS almost develop into liver fibrosis even cirrhosis and then die of encephalopathy and/or gastroesophageal hemorrhage without any treatments. The same does portal hypertension caused by HBV. But the prognosis of B-CS is disparate with the managements such as removaling the block of MHVs, outlets or/and performing the procedure of shunt. Recently, scholars all over the world have done a lot of work on the development and the reversion of liver fibrosis, espectially the status of VEGF and TIMP-1. Most of them suggest that VEGF is a prerequisite for the development of liver fibrosis and positively corelated with the grade of fibrosis; some argue that the higher expression of VEGF is a compensativeor/and adaptive reaction to the shortage of 02 in liver. The status of VEGE in liver fibrosis is not clear; as to TIMP-1, the majority contend that it stands for the viver fibrosis, others think it just a marker of the tendency of fibrosis. There is a large amount of documents on these issues but far beyond the consensus.In order to get the idea of VEGF and TIMP-1 in B-CS and portal hypertension, we detect the expression of VEGF and TIMP-1 in livers with B-CS or portal hypertension plus healthy people and investigate the status of VEGF and TIMP-1 in the development and reversion of liver fibrosis. We also want to evaluate the administration of VEGF blockade in the treatment of all kinds of portal hypertension, if possible.Data and methods: There were 42 patients in B-CS group including 23 males and 19 females; 24 males and 16 females composed of portal hypertension group; 12 controls were all from the emergency center. All subjects were excluded infection, myelodysplastic syndrome, antiphospholipid antibody syndrome, paroxysmal nocturnal hemoglobinuria, systemic lupus erithematosus and Bechet,s disease and other system diseases.We got all hepatic tissues of all the samples from the left lobes with almost the same volume. They were set by 10% formalin solution and then embedded in paraffin wax for24 hours. We carried out the experiments by method SP after 4 y m consistent slice. Finally, we used SPSSlO.Osoftware package to classify and analyze the statistic data.Results: VEGF and TIMP-1 are positive corelation with both hepatic fibrosis grades and the expression of CD34 in the patients with either BCS or HP. The expression of VEGF in BCS is much higher than that in HP. Whereas, the expression of TIMP-1 is lower. The expression of VEGF and TIMP-1 is positive corelation but the liver function and VEGF are negative corelation in all the patients.Conclusions: 1. The expression of VEGF in the patient with BCS is up-regulated and positive corelation with hepatic fibroticgrades through the research. We speculate that it is compensative reaction to hepatic hypoxia and this has positive clinical significance.2. The expressions of VEGF and MVD in the livers of patients with BCS are positive corelated and much higher than those with HP. Perhaps, these differences are direct reasons of the different prognosis of these two diseases.3. The effect of VEGF in liver fibrosis and the usage of VEGF blockade in the therapy of liver fibrosis are valuable for further research.4. The expression of TIMP-1 in B-CS is positive corelated with the hepatic fibrotic gradses and it is the marker of tendency for liver fibrosis.5. The differences of the expressions of VEGF and TIMP-1 in BCS and HP are possibly the internal reasons of the different fibrotic reversal and prognosis. Perhaps, VEGF realizes its effect by down-reglating the expression of TIMP-1.