门静脉高压药物治疗的新进展

Protective effect of omeprazole on gastric mucosal of cirrhotic portal hypertension rats

OBJECTIVE

To observe the protective effect of omeprazole on gastric mucosal of cirrhotic portal hypertension rats.

METHODS

All rats were randomly divided into normal control group, cirrhosis and treatment group. Thioacetamide was used to establish rat model of cirrhotic portal hypertension. The necrotic tissue of gastric mucosa ulcer focus, degree of neutrophils infiltration at the ulcer margin, portal pressure, portal venous flow, abdominal aortic pressure, abdominal aortic blood flow at front end, gastric mucosal blood flow (GMBF), glycoprotein (GP) of gastric mucosa, basal acid secretion, H(+)back -diffusion, gastric mucosal damage index, NO, prostaglandin E2(PGE2) and tumor necrosis factor-α (TNF-α) were determined respectively, and the pathological changes of gastric mucosa were also observed by microscope.

RESULTS

Compared with cirrhosis group and the control group, the ulcer bottom necrotic material, gastric neutrophil infiltration and UI of the treatment group were all decreased significantly (P<0.01), GMBF value, GP values, serum NO, PGE2, TNF-α were all significantly increased.

CONCLUSIONS

Omeprazole has an important protective effect on gastric mucosal and it can increase gastric mucosal blood flow and related to many factors.

Effect of reducing portal pressure on intestinal barrier function in patients with decompensated cirrhosis

AIM: To explore the effect of reducing portal pressure on intestinal barrier function in patients with decompensated cirrhosis.

METHODS: Eighty-six patients with decompensated viral liver cirrhosis or alcoholic cirrhosis were randomly divided into either an experiment group or a control group. The control group received conventional symptomatic and supportive treatment, and the experiment group was additionally given propranolol hydrochloride tablets. The width of the portal vein, alanine aminotransferase (ALT), aspartic transaminase (AST), total bilirubin (TBIL), serum albumin (ALB), plasma endotoxin level, D-lactic acid content and plasma diamine oxidase (DAO) were compared between the two groups.

RESULTS: The width of the portal vein in the experiment group posttreatment was significantly lower than that before treatment (1.37 cm ± 0.09 cm vs 1.41 cm ± 0.11 cm, P < 0.05) and that in the control group (1.37 cm ± 0.09 cm vs 1.39 cm ± 0.10 cm, P < 0.05). The levels of ALT, AST and TBIL in both groups posttreatment were significantly lower and the levels of ALB were significantly higher than those before treatment (35.15 U/L ± 11.92 U/L vs 42.76 U/L ± 18.06 U/L, 29.03 U/L ± 13.88 U/L vs 35.04 U/L ± 19.84 U/L, 19.57 μmol/L ± 10.59 μmol/L vs 25.65 μmol/L ± 15.09 μmol/L, 32.69 g/L ± 3.96 g/L vs 30.16 g/L ± 5.63 g/L, 34.03 U/L ± 11.46 U/L vs 42.91 U/L ± 17.67 U/L, 28.36 U/L ± 14.37 U/L vs 36.62 U/L ± 20.54 U/L, 18.94 μmol/L ± 9.56 μmol/L vs 24.92 μmol/L ± 16.60 μmol/L, 32.28 g/L ± 6.13 g/L vs 29.94 g/L ± 5.06 g/L, P < 0.05), although there were no significant differences in the levels of ALT, AST, TBIL and ALB between the two groups posttreatment (35.15 U/L ± 11.92 U/L vs 34.03 U/L ± 11.46 U/L, 29.03 U/L ± 13.88 U/L vs 28.36 ± 14.37 U/L, 19.57 μmol/L ± 10.59 μmol/L vs 18.94 μmol/L ± 9.56 μmol/L, 32.69 g/L ± 3.96 g/L vs 32.28 g/L ± 6.13 g/L, P > 0.05). Plasma endotoxin level, D-lactic acid content and DAO in the two groups posttreatment were significantly lower than those before treatment (0.53 EU/mL ± 0.12 EU/mL vs 0.72 EU/mL ± 0.11 EU/mL, 2.71 Ku/L ± 0.84 Ku/L vs 5.19 Ku/L ± 2.12 Ku/L, 7.85 mg/L ± 0.62 mg/L vs 12.95 mg/L ± 4.27 mg/L, 0.62 EU/mL ± 0.11 EU/mL vs 0.75 EU/mL ± 0.14 EU/mL, 3.83 Ku/L ± 1.70 Ku/L vs 5.34 Ku/L ± 2.08 Ku/L, 9.90 mg/L ± 6.70 mg/L vs 13.24 mg/L ± 4.42 mg/L, P < 0.05). Plasma endotoxin level, D-lactic acid content and DAO in the experiment group were significantly lower than those in the control group (0.53 EU/mL ± 0.12 EU/mL vs 0.62 EU/mL ± 0.11 EU/mL, 2.71 Ku/L ± 0.84 Ku/L vs 3.83 Ku/L ± 1.70 Ku/L, 7.85 mg/L ± 0.62 mg/L vs 9.90 mg/L ± 6.70 mg/L, P < 0.05).

CONCLUSION: Propranolol can not only improve liver function, reduce the width of the portal vein, decrease the levels of plasma endotoxin, D-lactic acid content and DAO, reduce portal hypertension, but also improve intestinal mucosal repair, reduce intestinal permeability, and improve intestinal barrier function.

Efficacy and cytotoxicity of a liver-targeted nitric oxide-releasing drug in the treatment of liver injury in mice

AIM: To evaluate the efficacy and cytotoxicity of NO-040527, a new liver-targeted nitric oxide-releasing drug, in the treatment of liver injury induced with carbon tetrachloride, acetaminophen or D-galactosamine in mice.

METHODS: Liver injury was induced in mice by intraperitoneal injection of carbon tetrachloride, acetaminophen or D-galactosamine. NO-040527 was orally administered to animals 1 h before and 12 h after the induction of liver injury. The animals were killed 24 h after drug delivery, and blood samples were taken to determine serum ALT and AST levels using an automatic biochemical analyzer. The cytotoxicity of the targeted conjugate was determined by methyl thiazol tetrazolium (MTT) assay.

RESULTS: NO-040527 could significantly inhibit carbon tetrachloride-induced elevation of ALT and AST in mice (both P < 0.01) in a dose-dependent manner. At the same dose (55 mg/kg), NO-040527 exhibited better efficacy than control drug NCX-1000 (P < 0.05) in lowering carbon tetrachloride-induced elevation of serum ALT and AST levels. Similarly, NO-040527 could also significantly inhibit acetaminophen-induced elevation of ALT and AST (both P < 0.01) though no dose-dependent effect was noted. At the same dose (55 mg/kg), NO-040527 exhibited similar efficacy to NCX-1000 in lowering acetaminophen-induced elevation of serum ALT and AST levels. NO-040527 showed no protective effects against liver injury induced with D-galactosamine. No significant differences were noted in serum ALT and AST levels between untreated mice with D-galactosamine-induced liver injury and those treated with medium- or low-dose NO-040527. However, the levels of serum ALT and AST in mice with D-galactosamine-induced liver injury treated with high-dose NO-040527 was higher than those in untreated ones. NO-040527 at a dose of 500 μmol/L began to show cytotoxicity (cell viability rate: 45.96% ± 29.46%; P = 0.058). Significant cytotoxicity was noted when the dose of NO-040527 rose to 1000 μmol/L (P < 0.005). NO-040527 at 50 and 100 μmol/L could accelerate cell growth (cell viability rate: 137.67% ± 8.47% and 152.65% ± 10.084%, respectively; both P < 0.05).

CONCLUSION: NO-040527 has good protective effects against carbon tetrachloride- or acetaminophen-induced liver injury in mice. NO-040527 is cytotoxic when used at high dose.