Turchetti V, Bellini M A, Leoncini F, Petri F, Trabalzini L, Guerrini M, Forconi S
Istituto di Medicina Interna e Geriatria, Università degli Studi di Siena, Italy.
Clin Hemorheol Microcirc. 2000;22(3):215-21.
Alterations of fluidity of the hepatocytic membrane and of the transport related systems are the basis of the cholesteatic syndrome and favour the tissue accumulation of cytotoxic metabolites. S-Adenosyl-L-Methionine (SAM) is a natural molecule which acts as a giver of methylic groups and as an enzymatic activator in several enzymatic actions of transmethylase and of transulphuration and plays a key role in biochemical processes of hepatic cell. The aim of our study was to evaluate the effects of SAM on the restoration of the membrane fluidity and on the hepatic function in general. In studying the fluidity of the cell membrane we evaluated some hemorheological parameters (total blood viscosity and red cell morphology). Fluidity of the red cell membrane is one of the most important elements of red cell rheology. We studied 15 patients (Group A) suffering from micro- and macro-nodular cirrhosis verified through hepatic biopsy, with alcoholic or post-viral causes. We evaluated the values of: blood viscosity (with a cone-plate rheometer by Carri-med), haematocrit, plasma fibrinogen and the erythrocytic morphology at the optical microscope with the Zipursky-Forconi method before and after 7 days of therapy with SAM i.v.. Data were compared with those of a similar group (Group B) treated with traditional therapy only (hyposodic and hypoprotein diet supplemented with multivitamin preparations, vitamin K in particular, if necessary, and potassium sparing diuretics). We also measured biliary salts, alkaline phosphatase, transaminase and gamma-GT. In the first group we observed a statistically significant reduction of blood viscosity, haematocrit didn't change significantly; biliary salts reduced in a statistically significant way. Evaluation of red cell morphology showed in all cases a pathological percentage (>15%) of echinocytes and knizocytes which reduced to a mean of 5% after SAM therapy. We observed no further modifications of the other hemorheological parameters. Results demonstrate that SAM has a positive action on the fluidity of the membrane, as indicated by the improvement of haemorheological parameters and by the significant decrease of biliary salts, indicating the presence of cholesteasis.
肝细胞膜流动性及相关转运系统的改变是胆汁淤积综合征的基础，且有利于细胞毒性代谢产物在组织中的蓄积。S-腺苷-L-蛋氨酸（SAM）是一种天然分子，它作为甲基供体，并在转甲基酶和转硫作用的多种酶促反应中作为酶激活剂，在肝细胞的生化过程中起关键作用。我们研究的目的是评估SAM对膜流动性恢复及总体肝功能的影响。在研究细胞膜流动性时，我们评估了一些血液流变学参数（全血粘度和红细胞形态）。红细胞膜流动性是红细胞流变学最重要的因素之一。我们研究了15例经肝活检证实为酒精性或病毒后病因导致的微结节和大结节性肝硬化患者（A组）。我们评估了以下指标的值：血液粘度（使用卡里-梅德锥板流变仪）、血细胞比容、血浆纤维蛋白原以及采用齐普尔斯基-福尔科尼方法在光学显微镜下观察的红细胞形态，这些指标在静脉注射SAM治疗7天前后进行评估。将数据与仅接受传统治疗的类似组（B组）的数据进行比较（低钠和低蛋白饮食，必要时补充多种维生素制剂，特别是维生素K，以及保钾利尿剂）。我们还测量了胆盐、碱性磷酸酶、转氨酶和γ-GT。在第一组中，我们观察到血液粘度有统计学意义的降低，血细胞比容无显著变化；胆盐有统计学意义的降低。红细胞形态评估显示，在所有病例中棘形红细胞和皱缩红细胞的病理百分比（>15%）在SAM治疗后降至平均5%。我们未观察到其他血液流变学参数有进一步变化。结果表明，SAM对膜流动性有积极作用，这表现为血液流变学参数的改善以及胆盐的显著降低，提示存在胆汁淤积。
