N-乙酰半胱氨酸对伴有肝硬化患者肝切除围手术期肝肾功能的保护作用

摘要/Abstract

摘要： 目的探讨N-乙酰半胱氨酸(NAC)联合乌司他丁对伴有肝硬化肝切除术患者围手术期肝肾功能的保护作用。方法选择2021年1月至2023年3月收治的择期行部分肝切除的肝硬化患者74例,随机分组为观察组和对照组,各为37例。对照组围手术期应用乌司他丁注射液治疗,观察组加用NAC注射液治疗;观察两组围手术期炎症氧化应激和肝肾功能指标的变化,以及安全性指标。结果术后3 d和7 d时,观察组的IL-1β和TNF-α水平分别为(43.59±6.17)、(35.94±5.10)μg/L和(26.53±3.91)、(20.48±3.27)ng/L,低于对照组的(47.92±6.58)、(39.71±5.76)μg/L和(29.86±4.35)、(25.61±3.80)ng/L,差异有统计学意义(t=6.524、6.249、6.725、7.314,均P<0.05)。观察组的MDA水平为(12.08±2.15)、(8.14±1.52)μmol/L,低于对照组的(14.35±2.39)、(9.82±1.76)μmol/L,观察组的SOD水平为(55.04±5.81)、(63.27±6.24)U/L,高于对照组的(52.15±5.46)、(58.79±6.43)U/L,差异有统计学意义(t=6.592、6.823、6.739、6.541,均P<0.05)。观察组的ALT、γ-GT、TBil、TBA、SF、RBP、CysC水平为(80.59±6.51)、(59.34±5.62)U/L和(90.15±6.83)、(64.28±5.74)U/L、(21.06±2.37)、(15.79±2.08)μmol/L和(11.54±1.90)、(9.64±1.57)μmol/L和(385.92±31.70)、(351.48±27.09)ng/mL,低于对照组的(86.73±7.04)、(67.19±6.47)U/L和(98.74±7.49)、(70.26±6.15)U/L、(22.79±2.51)、(17.84±2.35)μmol/L和(12.76±2.02)、(10.79±1.83)μmol/L和(407.59±34.28)、(369.85±30.63)ng/mL,观察组ALB水平为(30.78±2.18)、(32.51±2.46)g/L,高于对照组的(29.16±2.04)、(30.76±2.17)g/L,差异有统计学意义(t=6.853、7.128、6.784、6.573、5.487、6.284、5.185、5.384、6.719、5.826、5.438、5.629,均P<0.05)。观察组的RBP和CysC水平为(62.28±5.39)mg/L、(52.06±4.92)mg/L、(2.60±0.52)mg/L、(2.42±0.43)mg/L,低于对照组的(68.17±5.74)mg/L、(57.48±5.26)mg/L、(2.81±0.59)mg/L、(2.64±0.48)mg/L,差异有统计学意义(t=6.819、6.793、6.836、6.287,均P<0.05)。观察组的术后感染、HE、PHLF和AKI发生率为2.70%、2.70%、0、0,低于对照组的8.11%、10.81%、2.70%、5.41%,差异有统计学意义(χ²=3.284、3.827、3.496、3.608,均P<0.05)。结论 NAC联合乌司他丁能抑制具有肝硬化背景的肝切除术患者围手术期的炎症反应和氧化应激,发挥保护肝肾功能的作用。

关键词: 肝切除术, 肝硬化, 围手术期, N-乙酰半胱氨酸, 乌司他丁, 肝肾功能

Abstract: Objective To investigate the protective effect of N-acetylcysteine (NAC) combined with ulinastatin on liver and kidney function in cirrhosis patients who undergone hepatectomy during perioperative period. Methods A total of 74 patients with cirrhosis who underwent elective partial hepatectomy were selected from January 2021 to March 2023, and were randomly divided into observation group and control group (37 cases each). Control group was treated with ulinastatin injection during perioperative period, and observation group was treated with ulinastatin combined with NAC injection. The changes of inflammatory oxidative stress, liver and kidney function and safety indexes were observed in the two groups. Results The levels of IL-1β at 3 and 7 days after operation in the observation group were 43.59±6.17 μg/L and 35.94±5.10 μg/L, respectively, and TNF-α levles were 26.53±3.91 ng/L and 20.48±3.27 ng/L, respectively. These were significantly lower than the control group's IL-1β levels of 47.92±6.58 μg/L and 39.71±5.76 μg/L, and TNF-α levles of 29.86±4.35 ng/L and 25.61±3.80 ng/L (t=6.524, 6.249, 6.725, 7.314, all P<0.05). At 3 and 7 days post-operation, MDA levels in the observation group were 12.08±2.15 μmol/L and 8.14±1.52 μmol/L, which were lower than the control group's 14.35±2.39 μmol/L and 9.82±1.76 μmol/L. SOD levels in the observation group were 55.04±5.81 U/L and 63.27±6.24 U/L, significantly higher than 52.15±5.46 U/L and 58.79±6.43 U/L in control group (t=6.592, 6.823, 6.739, 6.541, all P<0.05). The levels of ALT, γ-GT, TBil, TBA, SF, RBP and CysC in the observation group were 80.59±6.51 U/L, 59.34±5.62 U/L, 90.15±6.83 U/L, 64.28±5.74 U/L, 21.06±2.37 μmol/L, 15.79±2.08 μmol/L, 11.54±1.90 μmol/L, 9.64±1.57 μmol/L, 385.92±31.70 ng/mL, 351.48±27.09 ng/mL, respectively, all significantly lower than 86.73±7.04 U/L, 67.19±6.47 U/L, 98.74±7.49 U/L, 70.26±6.15 U/L, 22.79±2.51 μmol/L, 17.84±2.35 μmol/L, 12.76±2.02 μmol/L, 10.79±183 μmol/L, 407.59±34.28 ng/mL, 369.85±30.63 ng/mL in the control group. The ALB levels in the observation group were 30.78±2.18 g/L and 32.51±2.46 g/L, which were significantly higher than those in the control group (29.16±2.04 g/L, 30.76±2.17 g/L; t=6.853, 7.128, 6.784, 6.573, 5.487, 6.284, 5.185, 5.384, 6.719, 5.826, 5.438, 5.629, all P<0.05). The levels of RBP and CysC in the observation group were 62.28±5.39 mg/L, 52.06±4.92 mg/L, 2.60±0.52 mg/L, 2.42±0.43 mg/L. It was lower than that of the control group (68.17±5.74 mg/L, 57.48±5.26 mg/L, 2.81±0.59 mg/L, 2.64±0.48 mg/L), with statistically significant difference (t=6.819, 6.793, 6.836, 6.287, all P<0.05). The incidence rates of postoperative infection, HE, PHLF and AKI in the observation group were 2.70%, 2.70%, 0%, and 0%, respectively, significantly lower than those in the control group (8.11%, 10.81%, 2.70%, and 5.41%; χ²=3.284, 3.827, 3.496, 3.608, all P<0.05). Conclusion NAC combined with ulinastatin can inhibit perioperative inflammatory response and oxidative stress in cirrhotic patients who undergone hepatectomy. NAC plays a protective role for liver and kidney function.

Key words: Hepatectomy, Liver cirrhosis, Perioperative period, NAC, Ulinastatin, Liver and kidney function

王志钢, 颜瑞龙, 袁翠华. N-乙酰半胱氨酸对伴有肝硬化患者肝切除围手术期肝肾功能的保护作用[J]. 肝脏, 2024, 29(7): 808-839.

WANG Zhi-gang, YAN Rui-long, YUAN Cui-hua. N-Acetylcysteine for liver and kidney function protection during the perioperative period of hepatectomy in the context of liver cirrhosis[J]. Chinese Hepatolgy, 2024, 29(7): 808-839.

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