Plasma endothelin in patients with endotoxemia and dynamic comparison between vasoconstrictor and vasodilator in cirrhotic patients

The association between clinical symptoms, laboratory findings and serum endothelin 1 concentrations, in cirrhotic patients with and without hepatopulmonary syndrome

AIM

This study evaluated the association between serum endothelin- 1 level and symptoms, clinical examination, laboratory and cardio-respiratory parameters, in patients with cirrhosis compared to controls.

BACKGROUND

Cirrhosis is associated with significant portal, pulmonary and systemic vascular abnormities. Recent studies have suggested that endothelin -1 may have a significant role in the regulation of vascular tone.

PATIENTS AND METHODS

In this case - control study, subjects that had been evaluated and diagnosed with biopsy-proven cirrhosis and age-matched controls with no evidence of cardio-vascular or liver disease were recruited. Review of medical records, routine laboratory investigations and cardio-respiratory investigations including echocardiography to look for evidence of hepato-pulmonary syndrome were performed.

RESULTS

50 patients were subjects were recruited. The most common aetiology of the cirrhosis was chronic hepatitis B viral infection. 7/50 cases had evidence of the hepatopulmonary syndrome. Among the patients with evidence of the hepatopulmonary syndrome, dyspnoea (100%) and cyanosis (90%) were the most common of the symptoms and signs recorded. Pao2 and arterial - alveolar oxygen gradients were the most sensitive tests in the diagnosis of hepatopulmonary syndrome. Orthodoxy specificity was 100%. The median concentration of serum endothelin-1 in cases with hepatopulmonary syndrome was 1.06+/- 0.015 pg/ml (range 0.92 - 1.21), in cases of sub-clinical hepatopulmonary syndrome, 2.49+/- 0.08 (4.05- 0.93) in patients with cirrhosis but no evidence of hepatopulmonary syndrome criteria 0.85+/-0.74(1.06-0.64) in controls.

CONCLUSION

There was a significant difference in serum endothelin- 1 levels between patients with cirrhosis and controls, but not between patients with cirrhosis complicated by hepatopulmonary syndrome and controls.

Infection et rupture de varice œsophagienne au cours de la cirrhose

Endotoxemia and bacterial infection are frequent in patients with cirrhosis. They alter systemic and splanchnic hemodynamics, worsen coagulation disorders, impair liver function and thus may induce variceal bleeding. In variceal bleeding, bacterial infection favours failure to control bleeding, early rebleeding, and death. In patients with cirrhosis and variceal bleeding, antibiotic-prophylaxis decreases bacterial infection and the incidence of early rebleeding, and, more important, significantly decreases the death rate in these patients.

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Effects of ET-1 and NO on hepatic hemodynamics at various stages of isolated perfused cirrhotic liver in rats

AIM

To investigate the effects of ET-1, NO on hepatic hemodynamics in isolated perfused rat liver at various stages of liver cirrhosis (LC).

METHODS

LC was induced by an intraperitoneal injection of CCL₄ combined with ethanol as drinking water. According to time points of CCL₄ injection, and combined with histopathological changes of liver and ascites, the isolated perfusion of liver was performed at a constant flow rate to determine the modulating effects of ET-1 and NO in the ends of 9th week (E-LC) and 14^th week (L-LC) after injected CCL₄.

RESULTS

After perfusion of L-NAME into the portal vein, there were no significant changes in the perfused pressure of portal vein (PP) and the hepatic venous pressure (Phv) of the L-LC group, the E-LC group and control group (P>0.05). After perfusion of ET-1, the PP of each group increased significantly (P<0.01). The elevated ranges of PP of the L-LC group was more than that of the E-LC group (P<0.01), both of which were higher than that of the control group (P<0.01). Compared with the ET-1 groups, the PP of the control group, the E-LC group and the L-LC group increased significantly (P<0.05) after perfusion of ET-1+L-NAME. There were no significant differences between the elevated ranges of PP of the L-LC and that of the E-LC group (P>0.05), both of which were more than that of the control group (P<0.01).

CONCLUSION

ET-1 plays a key role in elevating intra-hepatic resistance, facilitating synthesis of NO, which grow stronger in LC. With the development of LC, the compensation of NO decreases further. It is considered that antagonist of ET receptor and NO provider can increase synthesis of NO and be thus used in treatment of the high pressure of portal vein.

Effects of transmitters and interleukin-10 on rat hepatic fibrosis induced by CCl4

AIM: To study the effects of transmitters ET, AgII, PGI₂, CGRP and GG on experimental rat hepatic fibrosis and the antifibrogenic effects of IL-10.

METHODS: One hundred SD rats were randomly divided into 3 groups: control group (N): intraperitoneal injection with saline 2 mL·kg^-1 twice a week; the fibrogenesis group (C): intraperitoneal injection with 50% CCl₄ 2 mL·kg^-1 twice a week; IL-10 treated group (E): besides same dosage of CCl₄ given, intraperitoneal injection with IL-10 4 μg·kg^-1 from the third week. In the fifth, the seventh and the ninth week, rats in three groups were selected randomly to collect plasma and liver tissues. The levels of ET, AgII, PGI₂, CGRP and GG were assayed by radioimmunoassay (RIA). The liver fibrosis was observed with silver staining.

RESULTS: The hepatic fibrosis was developed with the increase of the injection frequency of CCl₄. The ET, AgII, PGI₂, CGRP and GG levels in serum of group N were 71.84 ± 60.2 ng·L^-1, 76.21 ± 33.3 ng·L^-1, 313.03 ± 101.71 ng·L^-1, 61.97 ± 21.4 ng·L^-1 and 33.62 ± 14.37 ng·L^-1, respectively; the levels of them in serum of group C were 523.30 ± 129.3 ng·L^-1, 127.24 ± 50.0 ng·L^-1, 648.91 ± 357.29 ng·L^{- 1}, 127.15 ± 62.0 ng·L^-1 and 85.26 ± 51.83 ng·L^{- 1}, respectively; the levels of them in serum of group E were 452.52 ± 99.5 ng·L^-1, 90.60 ± 44.7 ng·L^-1, 475.57 ± 179.70 ng·L^-1, 102.2 ± 29.7 ng·L^-1 and 38.05 ± 19.94 ng·L^-1, respectively. The histological examination showed that the degrees of the rats liver fibrosis in group E were lower than those in group C.

CONCLUSION: The transmitters ET, AgII, PGI₂, CGRP and GG play a significant role in the rat hepatic fibrosis induced by CCl₄. IL-10 has the antagonistic action on these transmitters and can relieve the degree of the liver fibrosis.

Effect of endotoxin on portal hemodynamic in rats

AIM: To study the effects of endotoxin on portal hemodynamic of normal and noncirrhotic portal hypertensive rats.

METHODS: Normal rats were intraperitonealy injected with 0.1, 0.25, 0.5, 1.0, 2.0, 4.0 mg·kg^-1 of lipopolysaccharide (LPS) respectively, portal vein ligation (PVL) and intrahepatic portal occlusion (IPO) rats as well as sham-operated rats were treated with an intraperitoneal injection of 1.0 mg·kg^-1 of LPS, the portal vein pressure (PVP), portal venous flow (PVF), inferior vena cava pressure (IVCP) and portal vein resistance (PVR) were detected 4 hours after injection.

RESULTS: PVF of the 5 groups of rats accepting intraperitoneal injection of LPS were increased from 14.0 to 18.0, 22.2, 26.2, 34.8, 39.6, 38.8 mL·min^-1 4 hours after injection of LPS (P < 0.01). PVP of the 4 groups of rats accepting more than 0.1 mg/kg·b.w of LPS was increased from 1.04 to1.25, 1.50, 1.80, 1.95, 2.05 kPa (P < 0.01). The increments of PVF and PVP were in a dose-dependent manner of LPS. PVR of the 5 groups of rats was decreased from 51 to 42, 44, 48, 45, 44, 47 kPa·min·L^-1 (P < 0.05) and no dose-dependent manner was observed. PVF of PVL, IPO and sham-operated rats increased from 22.6 to 32.8, 22.0 to 28.0, 14.0 to 34.8 mL·min^-1 (P < 0.01), and PVP increased from 1.86 to 2.24, 1.74 to 1.95, 1.04 to 1.80 kPa (P < 0.01), PVR decreased from 71 to 61, 67 to 61, 52 to 44 kPa·min·L^-1 after intraperitoneal injection of 1 mg·kg^-1 of LPS. The increments of PVF and PVP of PVL and IPO rats were significantly less than the sham-operated rats (P < 0.01), There was no significant difference between the amounts of PVR decreased in the two groups of PHT model rats and sham-operated rats (P > 0.05) after intraperitoneal injection 1 mg·kg^-1 of LPS.

CONCLUSION: Endotoxin could prompt portal hypertension of the normal and noncirrhotic portal hypertensive rats by increasing portal blood flow mainly.