乌司他丁联合异甘草酸镁和还原型谷胱甘肽对肝癌患者肝部分切除术后肝功能的保护效果初步研究

doi:10.3969/j.issn.1672-5069.2018.03.030

摘要/Abstract

摘要： 目的探讨乌司他丁联合异甘草酸镁和还原型谷胱甘肽对原发性肝癌（PLC）患者肝部分切除术后肝功能的保护效果。方法 2013年2月~2016年10月收治的78例PLC患者,行开腹或腔镜下肝部分切除术治疗,将术后患者分成两组,给予A组38例患者异甘草酸镁和还原型谷胱甘肽护肝、给予B组40例乌司他丁联合异甘草酸镁和还原型谷胱甘肽护肝治疗。采用ELISA法测定血清肿瘤坏死因子（TNF）-α、白介素（IL）-6和C反应蛋白（CRP）。结果术后7 d和14 d,B组血清谷丙转氨酶（ALT）水平显著低于A组（P<0.05）; 术后7 d,B组血清CRP、TNF-α和IL-6水平分别为（17.2±2.7） mg/L、（2.7±0.6） pg/ml和（28.4±5.7） pg/ml,均显著低于A组[（19.8±3.2） mg/L、（3.5±0.7） pg/ml和（33.4±6.2） pg/ml,P<0.05],术后14 d,分别为（13.6±3.0） mg/L、（2.0±0.4） pg/ml和（20.5±4.7） pg/ml,也显著低于A组 [分别为（16.3±3.5） mg/L、（2.8±0.6） pg/ml和（24.6±4.9）pg/ml,P<0.05];术后,A组与B组隔下积液、胆漏发生和死亡发生率比较,差异无统计学意义（P>0.05）,但B组肝衰竭发生率为2.5%,显著低于A组的21.1%（P<0.05）。结论乌司他丁联合异甘草酸镁和还原型谷胱甘肽可加强肝癌患者肝部分切除术后肝功能的保护作用,减轻机体炎症反应。

关键词: 原发性肝癌, 肝部分切除术, 乌司他丁, 肝功能

Abstract: Objective To investigate the protective effect of combination of ulinastatin with magnesium isoglycyrrhizinate and reduced glutathione on hepatic functions in patients with primary liver cancer after partial hepatectomy. Methods 78 patients with primary liver cancer were included in our hospital between February 2013 and October 2016,and they received partial hepatectomy. After operation,the patients were randomly divided into group B,receiving combination of ulinastatin,magnesium isoglycyrrhizinate and reduced glutathione,and group A,receiving magnesium isoglycyrrhizinate and reduced glutathione. Serum tumor necrosis factor （TNF）-α,interleukin （IL）-6 and C reactive protein（CRP） levels were detected by ELISA. Results There was no significant differences between the two groups as respect to the indexes of liver functions and serum inflammatory factors before operation（P>0.05）;serum alanine aminotransferase （ALT） level in group B seven days after operation were significantly lower than in group A （P<0.05）;at the end of seven days,serum CRP,TNF-α and IL-6 levels in group B were （17.2±2.7） mg/L,（2.7±0.6） pg/ml and （28.4±5.7） pg/ml,much lower than [（19.8±3.2） mg/L,（3.5±0.7） pg/ml and （33.4±6.2） pg/ml in group A,P<0.05],and at the end of 14 d,serum CRP,TNF-α and IL-6 levels in group B were（13.6±3.0） mg/L,（2.0±0.4） pg/ml and （20.5±4.7） pg/ml,much lower than[（16.3±3.5） mg/L,（2.8±0.6） pg/ml and（24.6±4.9）pg/ml in group A,P<0.05];there was no significant differences of the incidences of postoperative septal effusion,bile leakage and death between the two groups （P>0.05）,while the incidence of hepatic failure in group B was significantly lower than that in group A （2.5% vs. 21.1%,P<0.05）. Conclusion Combination of ulinastatin,magnesium isoglycyrrhizinate and reduced glutathionecan might enhance the protective effects on hepatic function in patients with primary liver cancer after partial hepatectomy.

Key words: Hepatoma, Partial hepatectomy, Ulinastatin, Liver functions

邓清, 张铁泉, 乐问津, 黄强, 李宓, 鲁号锋. 乌司他丁联合异甘草酸镁和还原型谷胱甘肽对肝癌患者肝部分切除术后肝功能的保护效果初步研究[J]. 实用肝脏病杂志, 2018, 21(3): 439-442.

Deng Qin, Zhang Tiequan, Yue Wenjin, et al. A preliminary study on the protective effect of combination of ulinastatin with magnesium isoglycyrrhizinate and reduced glutathione on liver functions in patients with primary liver cancer after partial hepatectomy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(3): 439-442.

参考文献

[1] Fuster J. Surgical treatment of hepatocellular carcinoma:should resection be performed according to Barcelona Clinic Liver Cancer classification Surg Today,2015,2(3):245-253.
[2] Zhang Y,Huang F,Wang J,et al.MiR-15b mediates liver cancer cells proliferation through targeting BCL-2. Int J Clin Exp Pathol,2015,8(12):15677.
[3] 吕运海,张焕常,申林杰,等. 解剖性肝叶切除术治疗原发性肝癌患者对肝功能及预后的影响. 实用肝脏病杂志,2017,20(4):504-506.
[4] Mehta A,Herrera H,Block T.Chapter seven-glycosylation and liver cancer. Adv Cancer Res,2015,126:257-279.
[5] Jiang G T,Chen X,Li D,et al.Ulinastatin attenuates renal interstitial inflammation and inhibits fibrosis progression in rats under unilateral ureteral obstruction. Mol Med Rep NLM,2014,10(3):1501-1508.
[6] Bacalbasa N,Balescu I,Tomescu D.Partial cystectomy with distal ureteral resection and re-implantation for locally invasive cervical cancer. Anticancer Res,2015,35(10):5539-5542.
[7] Prajapati HJ, Kim HS.Development of the new prognostic staging system(SS) in patients with unresectable hepatocellular carcinoma (HCC):multivariate survival analysis (MVA) -superior than Okuda,CLIP,BCLC,and Hong Kong Liver Cancer (HKLC) SSs. J Vasc Interv Radiol,2015,26(2):S66-S67.
[8] 高杰,朱继业. 卫生部《原发性肝癌诊疗规范(2011年版)》解读.中华普通外科杂志,2012,27(8):693-695.
[9] Robertson CL,Srivastava J,Rajasekaran D,et al.The role of AEG-1 in the development of liver cancer. Hepat Oncol,2015,2(3):303.
[10] Michele G,Chiara B.Non-coding RNAs in primary liver cancer. Front Med,2015,2(2):36.
[11] Sheng Z,Sun Y,Zhu R,et al.Functional cross-talking between differentially expressed and alternatively spliced genes in human liver cancer cells treated with berberine. Plos One,2015,10(11):e0143742.
[12] Alakilli SYM,Mahrous KF.Evaluation of the chemopreventive impacts of lactoferrin on the initiation of liver cancer induced by diethylnitrosamine in male mice. IJPSRR,2015,32(2):59-66.
[13] Fukami Y,Kaneoka Y,Maeda A,et al.Postoperative complications following aggressive repeat hepatectomy for colorectal liver metastasis have adverse oncological outcomes. Surg Today,2016,47(1):1-9.
[14] Salman A E,Yetisir F,Kilic M,et al.The impact of pretreatment with bolus dose of enteral glutamine on acute lung injury induced by oleic acid in rats. J Clin Anesth,2014,28(3):354.
[15] Fiorentini G,Carrandina R,Sarti D,et al.B24Hepatic arterial infusion of polythylene glycol drug-eluting beads for primary liver cancer therapy. Ann Oncol,2016,27(4):24.
[16] 朱毅,于冬男,赵国栋. 不同剂量乌司他丁预防肝部分切除术患者胰岛素抵抗的效果. 中华麻醉学杂志,2015,35(1):27-29.
[17] Cho Y S,Shin M S,Ko I G,et al.Ulinastatin inhibits cerebral ischemia-induced apoptosis in the hippocampus of gerbils. Mol Med Rep NLM,2015,12(2):1796.
[18] Tong Y,Tang Z,Yang T,et al.Ulinastatin preconditioning attenuates inflammatory reaction of hepatic ischemia reperfusion injury in rats via high mobility group box 1(HMGB1) inhibition. J Int Med Res,2014,11(4):337-343.
[19] 孙小聪,邵义明,黄河,等. 乌司他丁对脓毒症急性肾损伤肾功能的保护作用. 中华实验外科杂志,2015,32(4):910-912.
[20] Song B,Bian Q,Shao CH,et al.Ulinastatin reduces the resistance of liver cancer cells to epirubicin by inhibiting autophagy. Plos One,2015,10(3):e0120694.
[21] Yang B,Gao M,Wang K,et al.Intraintestinal administration of ulinastatin protects against sepsis by relieving intestinal damage. J Surg Res,2017,211(1):70-78.