| Objective: There has long been a debate on portal hypertensionpatients with spleen "stay or go", recent studies have shown that thespleen plays an important role in the onset and evolution of bothliver cirrhosis and portal hypertension, and the splenectomy ishelpful to reduce liver cirrhosis and promote liver regeneration, sosplenectomy seems to be an appropriate choice for cirrhotic patients,while the research is limited to animal studies, lacking of highquality clinical research cases of evidence-based medicine (EBM). HGFand TGF beta1are key cytokines that influence liver fibrosis andliver regeneration process. To this end, we design the paired clinicaltrials that test serological cytokines HGF, TGF beta1and liverfibrotic markers before and after splenectomy in patients with portalhypertension, preliminary study the effect of splenectomy on patientswith liver cirrhosis.Methods: Sequential choose30cases of portal hypertension who need toreceive devascularization process at the general surgery of People’sLiberation Army81st Hospital, all patients with negative HBV-DNAsuffered from chronic hepatitis B and did not receive antiviraltreatment preoperatively within half a year. We ruled out suchpatients with other chronic liver disease or liver cancer or surgicalcontraindications. All postoperative have been followed up more thansix months. The study period is from January2011to January2013. Totest the change of plasma platelet count, liver functional reserve, serological cytokines HGF, TGF-beta1and four liver fibrosis serummarkers HA, IV-C,LN, PIIINP before and after operation, respectivelyat preoperative and postoperative3days,1week,2weeks,3months,6months. Main detection methods: enzyme-linked immunosorbent methodmeasuring cytokines and chemical luminescence immunoassay testingliver fibrosis serum markers. Data analysis is taken by SPSS13.0software and the hypothesis test using variance analysis of repeatedmeasurement data.Results:(1) The platelet count before devascularization,2weeks,3months,6months after operation respectively are(×109/L):52±13,417±156,187±53,169±45postoperation significantly higher than preoperation(P<0.05).(2) Total bilirubin and total bile acid significantly decrease thanpreoperation half a year after surgery, the data respectively are(umol/L):25.6±10.4VS11.1±4.5,38±14VS9±3; Prealbumin andcholinesterase more higher than preoperation half a year afteroperation, the data respectively are:83±15VS117±22（mg/L）,2.9±0.5VS5.3±1.2（KU/L）.these differences all have statisticalsignificance.(3) The serum levels of HGF and TGF-β1before devascularization and3days,1week,2weeks,3months,6months after surgery respectively are(ng/L):529.3±216.7(Preoperation),744.5±276.4(POD3),591.5±156.8(POW1),550.5±169.4(POW2),463.2±139.8(POM3),485.4±152.1(POM6), POD3VS Preoperation(p<0.05),POM6VS Preoperation(p<0.05);444.2±90.7(Preoperation),416.7±69.1(POD3),374.5±45.2(POW1),369.2±81.9(POW2), 316.1±62.5(POM3),311.7±49.3(POM6),POW2VS Preoperation (P<0.05),POM6VS Preoperation(p<0.05).(4) The serum levels of HA,IV-C,LN,PIIINP preoperation and6monthsafter devascularization respectively are(ng/mL):267.1±88.6VS138.9±43.5,214.6±92.2VS120.2±53.4,242.1±101.6VS164.6±58.9,12.9±5.9VS6.1±2.4,the above differences have statistical significance.(5) The relationship between HGF,TGF-β1and HA,IV-C,LN,PIIINP haveshown positive correlation.Conclusions:(1) Devascularization is advantageous to cure hypersplenism,improveliver functional reserve.(2) Devascularization reduces TGF-beta1in the circulating blood,while HGF rises significantly higher than preoperative within2weeksafter surgery and down-regulate3months and6months after surgerycompared with preoperative. We speculate that devascularization couldhelp improve hepatocyte regenerative ability of cirrhosis,may havepositive effects on liver cirrhosis.(3) Devascularization reduces liver fibrosis serum markers HA, LN,IV-Cand PIIINP levels, may delay or reduce liver cirrhosis. |
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