Yurdaydin C, Karavelioglu D, Onaran O, Celik T, Yaşa M H, Uzunalimoglu O
Department of Gastroenterology, University of Ankara, Turkey.
J Hepatol. 1998 Nov;29(5):796-801. doi: 10.1016/s0168-8278(98)80261-4.
BACKGROUND/AIMS: Opioid peptides may contribute to some of the manifestations of hepatic encephalopathy. To address the role of the opioid system in the pathogenesis of hepatic encephalopathy, three representative opioid ligands were measured in plasma and cerebrospinal fluid of patients with hepatic encephalopathy.
Plasma and cerebrospinal fluid were obtained in three groups of patients: group 1: patients with hepatic encephalopathy; group 2: patients with lumbar back pain; group 3: healthy controls. Met-enkephalin, leu-enkephalin and beta-endorphin levels were measured in extracted plasma and cerebrospinal fluid samples by radioimmunoassay.
Plasma met-enkephalin levels were 656% (p<0.05) and 301% (p<0.05) and cerebrospinal fluid met-enkephalin levels were 1481% (p<0.01) and 645% (p<0.05) higher when compared to healthy control and pain control patients, respectively. Although plasma and cerebrospinal leu-enkephalin levels were elevated in patients with hepatic encephalopathy, the increases were not statistically significant. Plasma and cerebrospinal beta-endorphin levels were similar in the three study groups.
The results of this study support accumulating data on the role of the delta opioid receptor ligand met-enkephalin in the pathogenesis of hepatic encephalopathy, and provide a rationale for the use of opioid receptor antagonists in the treatment of hepatic encephalopathy.
背景/目的：阿片肽可能与肝性脑病的某些表现有关。为了探讨阿片系统在肝性脑病发病机制中的作用，我们检测了肝性脑病患者血浆和脑脊液中三种代表性阿片配体的水平。
选取三组患者获取血浆和脑脊液：第一组：肝性脑病患者；第二组：腰痛患者；第三组：健康对照者。采用放射免疫分析法测定提取的血浆和脑脊液样本中蛋氨酸脑啡肽、亮氨酸脑啡肽和β-内啡肽的水平。
与健康对照者和疼痛对照组患者相比，肝性脑病患者血浆中蛋氨酸脑啡肽水平分别升高656%（p<0.05）和301%（p<0.05），脑脊液中蛋氨酸脑啡肽水平分别升高1481%（p<0.01）和645%（p<0.05）。虽然肝性脑病患者血浆和脑脊液中亮氨酸脑啡肽水平升高，但升高幅度无统计学意义。三个研究组的血浆和脑脊液β-内啡肽水平相似。
本研究结果支持关于δ阿片受体配体蛋氨酸脑啡肽在肝性脑病发病机制中作用的越来越多的数据，并为使用阿片受体拮抗剂治疗肝性脑病提供了理论依据。
