| Objiective:To explore the effects of partial splenic artery embolization(PSE)on serum platelet-derived factor(PDGF),transforming growth factor-?1(TGF-?1),liver fiber and liver function in patients with cirrhosis and hypersplenism.Methods:A total of 36 patients with hepatitis cirrhosis and hypersplenism who underwent PSE surgery from the First Affiliated Hospital of Kunming Medical University from October 2018 to December 2019 were collected.Peripheral blood was collected to analyze platelet-derived factor(PDGF)and transforming growth before and after PSE Factor-?1(TGF-?1),liver fiber four items,blood routine,liver function and immune indicators(NK cells and Th2 lymphokine IL-6)changes,while using liver ultrasound images and transient elastography imaging to detect liver stiffness(LSM)changes.Results:1.Changes of PDGF and TGF-?1:Control group:PDGF value was 98.26 ±10.12ng/L,TGF-?1 value was 180.36±12.38ng/L;test group:preoperative PDGF value was 213.36±15.42ng/L,TGF-?1 value was 263.26±21.47ng/L,7 days after operation,PDGF value is 200.04±12.13ng/L,TGF-?1 value is 260.18±17.37ng/L;PDGF value is 195.41±14.22ng/L,TGF-?1 value is 262.43±16.42ng/L after 1 month after operation;PDGF value was 198.34±12.66ng/L and TGF-?1 value was 261.96±14.75ng/L at 3 months after operation.Compared with the normal control group,PDGF and TGF-?1 increased significantly after hypersplenism,and PDGF showed a downward trend after PSE.The difference between 1 week,1 month,and 3 months after surgery was statistically significant compared with that before surgery.TGF-?1 There was no statistically significant difference between 1 week,1 month and 3 months after operation compared with before operation.2.Changes in four liver fibers:Control group:HA value:119.65±9.35ng/L;Pc?:4.58±1.20ug/L;LN:107.38±13.67ug/L;?-C:7.45±1.18ug/L.test group:Preoperative HA value:231.37±47.28ng/L;Pc?:12.25±2.36ug/L;LN:215.11 ± 63.28ug/L;?-C:14.96±4.76ug/L;7 days after PSE HA:203.25±38.79 ng/L;Pc?:10.13 ± 1.42ug/L;LN:173.26±54.39ug/L;?-C:12.63±3.76ug/L.1 month postoperative HA:186.71±42.36ng/L;Pc?:8.73±1.72ug/L;LN:148.02 ±43.29ug/L;?-C:9.40±2.0ug/L;3 month postoperative HA:198.23±35.66ng/L;Pc?:9.76±2.25ug/L;LN:168.77±58.67ug/L;IV-C:10.65±1.91ug/L.Compared with the normal control group,the four items of liver fibrosis(HA,Pc?,LN and?-C)were significantly increased in the experimental group before operation,and the four items of liver fibrosis after PSE were 1 week,1 month,3 after PSE Months showed a significant decrease compared with pre-operation,in which the postoperative month decreased to the lowest,and the postoperative 3 months increased compared with the postoperative month.3.Changes in liver stiffness value(LSM):Normal population LSM is less than 7.3Kpa,patients with cirrhosis and spleen hyperactivity have 20.51 ± 6.01Kpa before operation,20.08±5.92Kpa 1 week after operation,16.50 ± 4.33Kpa 1 month after operation,17.79±4.04Kpa 3 month after operation.Liver stiffness decreased slightly at 1 week after PSE,and the difference was not statistically significant.There was a significant decrease at 1 and 3 months after surgery compared to before surgery,and there was an increase at 3 months after surgery compared to 1 month after surgery.Statistical significance.4.Changes in immune indicators(NK cells and IL-6):The normal range of NK cells is 90-590 cells/uL,and the normal range of IL-6 is 1.18-5.30pg/mL.NK cells in patients with cirrhosis and hypersplenism were 61.04±25.29/uL before surgery,114.53 ±31.23/uL at 1 week after surgery,103.78 ± 36.25/uL at 1 month after surgery,and 99.38±27.39 at 3 months after surgery/UL;IL-6 was 9.75±3.25pg/mL before operation,73.26±31.59pg/mL at 1 week after operation,13.44±7.65pg/mL at 1 month after operation,and 5.35±7.51 pg/mL at 3 months after operation.Liver cirrhosis and hypersplenism NK cells were significantly lower than the lower limit of normal before operation,and increased significantly at 1 week,1 month and 3 months after operation.Th1/Th2 cell lymphokine changes:Th2 secreted cytokine IL-6 was higher than the upper limit of normal before operation,increased significantly at 1 week after operation,significantly decreased at 1 month after operation,and returned to the normal range within 3 months;the remaining Thl/Th2 lymphocytes secreted by Th2 showed no significant changes at three time points(1 week,1 month,3 months)compared with those before operation(p>0.05).5.Changes in blood routine:After 1 week,the white blood cells quickly rose to the highest level and then began to decline,and after 3 months they fell below the normal value.After the operation,the platelet rapidly increased within 1 week to the normal range,reached the peak level in January,and then slowly declined.6.Changes in liver function:At 3 days,1 week,1 month and 3 months after operation,alanine aminotransferase(ALT)did not change significantly(p>0.05);3 days and 7 days after surgery,AST was significantly higher than before surgery,the difference was statistically significant,Aspartate aminotransferase(AST)decreased 7 days after surgery compared with 3 days after surgery(P<0.05),and returned to preoperative level 1 month after surgery(P>0.05),and there was no significant change at 3 months after surgery compared with preoperative(P>0.05).The prothrombin time(PT)and total bilirubin(TBil)were significantly increased at 3 days and 7 days after surgery,and decreased at 7 days after surgery compared to 3 days after surgery.It dropped significantly after March.One week after surgery,IL-6 levels increased significantly,and liver function indexes(AST,TBil,and PT)also increased,and there was a positive correlation between the two.7.Correlation analysis of TGF-?1,PDGF and platelets:There was a negative correlation between TGF-?1 and PDGF and platelets before and after operation(preoperative:r=-0.594,p<0.05,r=-0.762,p<0.05;postoperative:r=-0.357,p<0.05,r=-0.685,p<0.05).Conclusions:1.Hepatitis cirrhosis due to hypersplenism leads to decreased platelets,pro-fibr otic factors PDGF and TGF-?1 increase,NK cell number decreases and IL-6 increases;meanwhile,four items of liver fibrosis increase and liver stiffness va lue increase,suggesting splenic function Hyperactivity can lead to increased liv er fibrosis factors,which may increase liver fibrosis.2.After PSE,platelets increase,PDGF and TGF-?1 decrease,NK cells increa se,IL-6 decreases;meanwhile,four items of liver fibrosis decrease and liver st iffness value decrease,suggesting that PSE can cause liver fibrosis factor Decr ease,thereby alleviating the process of liver fibrosis.3.PSE can cause transient damage to liver function,gradually recover after 1 week,and return to preoperative level in January and gradually improve,sugge sting that PSE can improve function.4.PSE can improve the peripheral white blood cells and platelets of patients,and achieve the purpose of correcting hypersplenism. |
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