Coşkun U, Ozenirler S, Sancak B, Bukan N
Department of Internal Medicine, Gazi University Medical School, Ankara, Turkey.
Clin Chim Acta. 2001 Apr;306(1-2):127-32. doi: 10.1016/s0009-8981(01)00414-4.
Increased nitric oxide level may play a critical role in the hemodynamic disturbances in patients with cirrhosis. There are few reports investigating the factors related to this increase and their results are controversial. The purpose of this study was to reveal the clinical importance of nitric oxide levels and the possible factors related to this increase in patients with cirrhosis.
Serum and ascites nitrate levels were studied in 50 patients with cirrhosis and 10 control subjects.
All cirrhotic patients (groups 2, 3, 4, 5, 6) showed significant increase in serum nitrate levels in comparison with that in control subjects (group 1) (p<0.001). Serum nitrate levels were significantly higher (282.4+/-111.3 micromol/l; p<0.05) in patients with spontaneous bacterial peritonitis (group 2) when compared with those in cirrhotic patients without spontaneous bacterial peritonitis (group 3) (186.4+/-87.6 micromol/l). Ascitic fluid nitrate levels were significantly higher (302.4+/-66 micromol/l; p<0.001) in patients with spontaneous bacterial peritonitis (group 2) when compared with those in cirrhotic patients without spontaneous bacterial peritonitis (group 3) (135.4+/-65.8 micromol/l). Serum nitrate levels were significantly lower in cirrhotic patients without ascites (group 5) when compared with those in cirrhotic patients with ascites (group 3) (98.8+/-52.6 vs. 186.4+/-87.6 micromol/l; p<0.05). No significant differences were found among patients with severe anemia (groups 4, 6) and other cirrhotic patients (group 3) (174.5+/-54.5, 168.8+/-63.8 vs. 186.4+/-87.6 micromol/l; p>0.05). Cirrhotic patients with Child--Pugh B and C scores showed higher serum nitrate levels (179.4+/-81.1, 222.5+/-101.7 micromol/l; p<0.001) than did cirrhotic patients with Child--Pugh A score (85.8+/-59.7 micromol/l).
Our findings suggest that overproduction of nitric oxide in cirrhotic patients may be related to the severity of liver damage and spontaneous bacterial peritonitis but not related to their anemia.
一氧化氮水平升高可能在肝硬化患者的血流动力学紊乱中起关键作用。关于研究与此升高相关因素的报道较少，且结果存在争议。本研究的目的是揭示一氧化氮水平在肝硬化患者中的临床重要性以及与此升高相关的可能因素。
对50例肝硬化患者和10例对照者的血清及腹水硝酸盐水平进行了研究。
与对照者（第1组）相比，所有肝硬化患者（第2、3、4、5、6组）的血清硝酸盐水平均显著升高（p<0.001）。与无自发性细菌性腹膜炎的肝硬化患者（第3组）（186.4±87.6微摩尔/升）相比，自发性细菌性腹膜炎患者（第2组）的血清硝酸盐水平显著更高（282.4±111.3微摩尔/升；p<0.05）。与无自发性细菌性腹膜炎的肝硬化患者（第3组）（135.4±65.8微摩尔/升）相比，自发性细菌性腹膜炎患者（第2组）的腹水硝酸盐水平显著更高（302.4±66微摩尔/升；p<0.001）。与有腹水的肝硬化患者（第3组）相比，无腹水的肝硬化患者（第5组）的血清硝酸盐水平显著更低（98.8±52.6对186.4±87.6微摩尔/升；p<0.05）。重度贫血患者（第4、6组）与其他肝硬化患者（第3组）之间未发现显著差异（174.5±54.5、168.8±63.8对186.4±87.6微摩尔/升；p>0.05）。Child-Pugh B级和C级评分的肝硬化患者的血清硝酸盐水平（179.4±81.1、222.5±101.7微摩尔/升；p<0.001）高于Child-Pugh A级评分的肝硬化患者（85.8±59.7微摩尔/升）。
我们的研究结果表明，肝硬化患者一氧化氮的过度产生可能与肝损伤的严重程度和自发性细菌性腹膜炎有关，但与贫血无关。
