Changes of gastrointestinal hormones before and after hepatic ischemia reperfusion and the role of salvia miltiorrhiza pretreatment / 中华消化外科杂志

ABSTRACT

Objective To study the changes of gastrointestinal hormones before and after hepatic ischemia reperfusion and the role of salvia miltiorrhiza pretreatment.Methods The clinical data of 32 patients with hepatic diseases who were admitted to the Wuhan General Hospital of Guangzhou Military Area of PLA from May 2010 to May 2012 were prospectively analyzed.Thirty-two patients with hepatic inflow occlusion were randomly divided into the ischemia reperfusion group (IR group,15 patients) and salvia miltiorrhiza pretreatment group (SM group,17 patients).Patients in the IR group and SM group received partial hepatectomy with hepatic inflow occlusion by Pringle maneuver for 15-20 minutes.Patients in the IR group and SM group were injected with normal saline and salvia miltiorrhiza (30 mL/d) by intravenous drip for 3 days before operation,respectively.Twelve patients with hepatic diseases who received open surgery without block of hepatic inflow occlusion were enrolled in the negative control group (SO group) and 5 healthy volunteers were enrolled in the normal control group (CO group).The changes of the motilin,cholecystokinin,vasoactive intestinal peptide and secretin of the 4 groups were recorded.All data were analyzed using the analysis of variance or LSD-t test.Results The level of motilin of the CO group was (347 ± 14)μg/L.The levels of motilin of the SO group,IR group,and SM group at postoperative 24,48 and 72 hours were (324 ± 13) μg/L,(345 ± 12)μg/L,(345 ± 13)μg/L,(307 ± 10)μg/L,(316 ±9)μg/L,(338 ±13) μg/L,(313 ± 7) μg/L,(337 ± 12) μg/L and (345 ± 12) μg/L,respectively.The level of motilin of the SO group at postoperative 24 hours was significantly lower than that of the CO group (t =5.25,P ＜ 0.05) ; the levels of motilin of the IR group at postoperative 24,48 and 72 hours were significantly lower than those of the SO group (t =10.05,8.09,2.07,P ＜0.05) ; the levels of motilin of the SM group at postoperative 24 and 48 hours were significantly lower than those of the SO group (t =9.83,2.28,P ＜ 0.05),while there was no significant difference in the level of motilin between the SM group and the SO group at postoperative 72 hours (t =0.36,P ＞0.05) ;the levels of motilin of the SM group at postoperative 24,48 and 72 hours were significantly higher than those of the IR group (t =3.80,7.10,2.35,P＜0.05).The levels of cholecystokinin of the CO group was (2.53±0.06)μg/L.The levels of cholecystokinin of the SO group,IR group and SM group at postoperative 24 hours were (3.28 ±0.09) μg/L,(2.52 ±0.09) μg/L,(2.54 ±0.16)μg/L,(4.34 ±0.21) μg/L,(3.63 ±0.31)μg/L,(3.25 ± 0.09) μg/L,(3.71 ±0.28)μg/L,(3.28±0.11)μg/L and (2.53 ±0.09)μg/L,respectively.The level of cholecystokinin of the SO group at postoperative 24 hours was significantly higher than that of the CO group (t =4.33,P ＜ 0.05) ; the levels of cholecystokinin of the IR group at postoperative 24,48and 72 hours were significantly higher than those of the SO group (t =9.32,5.37,2.16,P＜0.05) ; the levels of cholecystokinin of the SM group at postoperative 24 and 48 hours were significantly higher than those of the SO group (t =7.21,3.42,P ＜ 0.05),while there was no significant difference in the level of cholecystokinin between the SM group and the SO group at postoperative 72 hours (t =0.29,P ＞ 0.05) ; the levels of cholecystokinin of the SM group at postoperative 24,48 and 72 hours were significantly higher than those of the IR group (t =5.62,4.63,3.57,P ＜ 0.05).The level of vasoactive intestinal peptide of the CO group was (11.8 ±1.6) tμg/L.The levels of vasoactive intestinal peptide of the SO group,IR group,and SM group at postoperative 24,48 and 72 hours were (21.5 ± 3.8) μg/L,(12.2 ± 1.6) μg/L,(11.9 ± 1.7) μg,/L,(29.7 ± 4.1) μg/L,(22.9±4.2)μg/L,(18.8±2.8)μg/L,(22.4 ±4.1)μg/L,(16.4±2.3)μg/L and (12.1 ±1.6)μg/L,respectively.The level of vasoactive intestinal peptide of the SO group at postoperative 24 hours was significantly higher than that of the CO group (t =3.59,P ＜ 0.05) ; the levels of vasoactive intestinal peptide of the IR group at postoperative 24,48 and 72 hours were significantly higher than those of the SO group (t =6.35,3.22,2.36,P ＜ 0.05) ; the levels of vasoactive intestinal peptide of the SM group at postoperative 24 and 48 hours were significantly higher than those of the SO group (t =5.04,2.33,P ＜ 0.05),while there was no significant difference in the level of vasoactive intestinal peptide between the SM group and the SO group at postoperative 72 hours (t =0.18,P ＞ 0.05) ;the levels of vasoactive intestinal peptide of the SM group at postoperative 24,48and 72 hours were significantly lower than those of the IR group (t =4.27,3.87,2.45,P ＜ 0.05).The level of secretin of the CO group was (75 ± 5) μg/L.The levels of secretin of the SO group,IR group and SM group at postoperative 24,48 and 72 hours were (98 ± 6) μg/L,(76 ± 4) μg/L,(76 ± 4) μg/L,(129 ± 6) μg/L,(102 ±8) μg/L,(89 ± 6) μg/L,(104 ± 8) μg/L,(90 ± 6) μg/L and (74 ± 4) μg/L,respectively.The level of secretin of the SO group at postoperative 24 hours was significantly higher than that of the CO group (t =3.27,P ＜ 0.05) ;the levels of secretin of the IR group at postoperative 24,48 and 72 hours were significantly higher than those of the SO group (t =5.20,2.94,1.77,P ＜ 0.05) ; the level of secretin of SM group at postoperative 24 and 48 hours were significantly higher than those of the SO group (t =4.16,2.54,P＜0.05),while there was no significant difference in the level of secretin between the SM group and the SO group at postoperative 72 hours (t =0.23,P ＞ 0.05) ; the levels of secretin of the SM group at postoperative 24,48 and 72 hours were significantly lower than those of the IR group (t =5.13,4.32,2.87,P ＜ 0.05).Conclusions Gastrointestinal congestion caused by hepatic blocking leads to the decline of the expression of motilin,but the increase of the expression of cholecystokinin,vasoactive intestinal peptide,secretin.Salvia miltiorrhiza may improve micro-circulation,abate gastrointestinal adema,and influence the gastrointestinal hormone expression in an indirect way.