| Objective: Esophageal and gastric varices bleeding is one of the mostcommon and serious complications of liver cirrhosis and portal hypertension,which is also the leading cause of death in the patients. So it must be takenrapid and effective methods to reduce the patient's bleeding and death rate.With the development and popularization of digestive endoscopy, endoscopictreatment has gradually becomed the main method to prevent and treatgastroesophageal varices of liver cirrhosis. Endoscopic treatment mainlyinclude esophageal varices ligation (EVL), endoscopic injection sclerotherapy(EIS), tissue adhesives injection and combination therapy. Collateralcirculation is blocked in different degree after endoscopic treatment, portalvein blood flow can change, but the affects on vasoactive factor in literaturesare less. Both the vasoconstrictor of urotensin-II(UII), endothelin-1(ET-1)and the vasodilator of vasoactive intestinal peptide(VIP) all play major roles inthe development of liver cirrhosis and portal hypertension. The objective ofthe experiment were to observe the changes of three vasoactive factors afterendoscopic treatment and to study the relationship between them and thedegree of gastroesophageal varices and Child-Pugh classification. It alsodiscussed the impact of endoscopic treatment on plasma vasoactive factors,providing the theory basis for stabilizing portal hypertension and reducingcomplications.Methods: Fifty patients diagnosed as gastroesophageal varices of theliver cirrhosis were involved in the study from May2011,30th to December2011,20th in department of gastroenterology of second hospital of HeBeimedical university.29of50cases were male and21were females, age rangedfrom24to77years old, the mean age was51years. According to Child-Pugh classification standards, grade A included28cases, grade B included17cases,and grade C included5cases. Liver cirrhosis of hepatitis B were35cases,liver cirrhosis of hepatitis C were4cases, liver cirrhosis of hepatitis Bcombining with alcoholic cirrhosis were5cases, cavernous transformation ofportal vein were3cases, cryptogenic cirrhosis were3cases. This patientsreceived endoscopic treatment by using OlympusXQ240/260gastrointestinalvideoscope. The patients were divided to EVL group, EIS group andcombination therapy group according to different endoscopic methods anddivided to Child-Pugh A, B, C according to Child-Pugh classification.Collected the peripheral blood samples from the patients in the morning, thencentrifugated at3000ram for15minitues, separated the plasma and preservedthem in-40℃refrigerator. Plasma UII and VIP were assayed by using enzymeleague immune analysis(ELISA), plasma ET was assayed by using radiationimmune analysis. Observed the changes of above indexes in different groups,time and Child-Pugh classifications. SPSS13.0software was used forstatistical analysis, Repeated Measurement Analysis was used for analysisingthe numerical variable data. Statistically significant level was considered as"P<0.05".Results：1The level of plasma UIIThe level of plasma UII had no significant differences betweenpre-operation and post-operation (P>0.05); the level of plasma UII beforetreatment had significant differences among Child-Pugh A, B and C (P<0.05),there were no significant differences between A and B (P>0.05), there weresignificant differences between A and C (7.38±2.81pg/ml vs10.44±2.05pg/ml,P<0.05), there were significant differences between B and C (7.28±3.66pg/mlvs10.44±2.05pg/ml, P<0.05); there were no significant differences betweenpre-operation and post-operation in Child-Pugh A, B and C(P>0.05); the levelof plasma UII had no significant differences between EVL, EIS andcombination therapy groups(P>0.05). 2The level of plasma ETThe level of plasma ET had no significant differences betweenpre-operation and post-operation (P>0.05); the level of plasma ET beforetreatment were significant differences among Child-Pugh A, B and C(P<0.05);there were no significant differences between A and B(P>0.05); there weresignificant differences between A and C (42.05±15.29pg/ml vs62.04±7.75pg/ml, P<0.05), there were significant differences between B and C(46.96±10.49pg/ml vs62.04±7.75pg/ml, P<0.05); there were no significantdifference between pre-operation and post-operation in Child-Pugh A, B(P>0.05); there were significant difference between before endoscopictreatment and after the7day in Child-Pugh C (62.04±7.75pg/ml vs81.54±12.44pg/ml, P<0.05); the level of plasma ET had no significantdifferences between EVL, EIS and combination therapy groups(P>0.05).3The level of plasma VIPThe level of plasma VIP had no significant differences betweenpre-operation and post-operation (P>0.05); the level of plasma VIP beforetreatment had significant differences among Child-Pugh A, B and C (P<0.05);there were no significant differences between A and B (P>0.05), there weresignificant differences between A and C (34.45±16.94pg/ml vs58.96±10.43pg/ml, P<0.05), there were significant differences between B andC (39.94±21.71pg/ml vs58.96±10.43pg/ml, P<0.05); there were nosignificant differences between pre-operation and post-operation inChild-Pugh A, B and C (P>0.05); the level of plasma VIP had no significantdifferences between EVL, EIS and combination therapy groups(P>0.05).Conclusion：1In the patients of liver cirrhosis and portal hypertension, the levels ofplasma UII, ET, VIP gradually increased with the severity of Child-Pughclassification.2In different Child-Pugh classification, the levels of plasma UII, VIPhad not obvious change after endoscopic treatment. The level of plasma ETrised distinctly only in Child-Pugh C after endoscopic treatment, but becauseof this group samples were less, clinical significance needed to be discussed. 3Different endoscopic treatment methods (including EVL, EIS and thecombination therapy) had no significant influences on the levels of plasma UII,ET, VIP.4Endoscopic treatment of gastroesophageal varices has no significantinfluences on the levels of plasma UII, ET, VIP. |
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