| Objective: The influence mechanism of pathological spleen to Hepatitis B patients with cirrhosis and portal hypertension is still unclear, whether the pathologic spleen should be saved in portal hypertension patients is widespread concerned.Recent studies shown that pathological spleen can promote disease in patients with cirrhosis and removal of the spleen can effectively slow down the process of cirrhosis,it can improve liver function,too. However, the researches are limited to animal studies, lacking the support of clinical trials. Matrix metalloproteinase-1(MMP-1) and tissue inhibitor of matrix metalloproteinase-1(TIMP-1) affecting the liver extracellular matrix degradation balance,are the most direct course of liver fibrosis cytokines. In order to explore the impact of splenectomy plus devascularization on liver cirrhosis, we design the paired clinical trials that test serological cytokines MMP-1, TIMP-1 beta1 and liver fibrotic markers before and after the operation.Methods: Twenty consecutive portal hypertensive patients with positive HBs Ag and negative HBV-DNA and Child-Pugh A or B were collected in this study.ELISA method was used to test the level of serum MMP-1and TIMP-1;electrochemical luminescence was used to measure hyaluronic acid(HA), N-terrninal type III procollagen peptide(PC-III),laminin(LN) and collagen typeⅣ(C-IV);total bilirubin(TIBL),aspartate and alanine transaminases( AST,ALT),cholinesterase(CHE),prealbumin(PA) and number of white blood cell(WBC) and platelel(PLT) were measured by biochemical and blood cell analyzer. Data analysis is taken by SPSS 20.0 software and the hypothesis test using variance analysis of repeated measurement data.Results:(1) The serum levels of MMP-1 before surgery and 3 days,3 weeks,1 month,4 months,6 months after surgery respectively are(ng/L): 277.11±40.10(Preoperation) 、179.39±50.10(POD3) 、 371.75±29.49(POW3) 、 372.30±27.14(POM1) 、 383.98±19.30(POM4)、377.40±5.98(POM6),compared with the preoperative they were statistically significant(p<0.05); The serum levels of TIMP-1 before devascularization and 3 days,3 weeks,1 month,4 months,6 months after surgery respectively are(ng/L): 33.66±1.92(Preoperation) 、 27.05±4.40(POD3) 、 27.30±2.17(POW3) 、 25.29±1.95(POM1) 、23.31±1.48(POM4) 、22.88±1.45(POM6), POW3 、POM1 、POM4 、POM6 compared with the preoperative were statistically significant(p<0.05).(2) The monitoring of HA、LN、PC-Ⅲ、Ⅳ-C showed a downward trend since 4 months after surgery, Compared with preoperative, the differences are all statistically significant(p<0.05).(3) The changes between TIMP-1 and HA, PC-III, LN, C-IV are positively correlated(r=0.458~0.783,P<0.01/0.05), The changes between MMP-1 and HA,PCIII,LN,C-IV are negatively correlated(r=-0.545~-0.873,P<0.01/0.05).(4) The monitoring of TBIL showed a downward trend after surgery, POW2、 POW3、POM1、POM6 compared with the preoperative were statistically significant(p <0.05). PA reduce postoperative 3d, then gradually increased, Except for POW1 the differences are all statistically significant(p<0.05). AST and ALT lower than the preoperative 、CHE increased compared with preoperative:(POW3) 、(POM1)、(POM4)、(POM6) compared with the preoperative were statistically significant(p <0.05).(5)The amount of WBC and PLT were significantly higher than the preoperative levels, stabilized at normal levels after 4 months, and 6 months later.Conclusions:(1) Splenectomy plus esophagogastric devascularization can decline noninvasive hepatic fibrosis serum markers and cytokines(TIMP-1),while,the MMP-1’s content is slow increase. Conducive to slow disease progression in patients with cirrhosis.(2) Splenectomy plus esophagogastric devascularization can improve liver function reserve and hypersplenism. |
PDF Full Text Request