肾上腺髓质素与肝硬化和非肝硬化门静脉高压症

Adrenomedullin in cirrhotic and non-cirrhotic portal hypertension.

作者信息

Tahan V, Avsar E, Karaca C, Uslu E, Eren F, Aydin S, Uzun H, Hamzaoglu H O, Besisik F, Kalayci C, Okten A, Tozun N

机构信息

Gastroenterology Institute, Marmara University, Turkey.

出版信息

World J Gastroenterol. 2003 Oct;9(10):2325-7. doi: 10.3748/wjg.v9.i10.2325.

DOI:10.3748/wjg.v9.i10.2325

PMID:14562402

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4656487/

Abstract

AIM

Adrenomedullin (ADM) is a potent vasodilator peptide. ADM and nitric oxide (NO) are produced in vascular endothelial cells. Increased ADM level has been linked to hyperdynamic circulation and arterial vasodilatation in cirrhotic portal hypertension (CPH). The role of ADM in non-cirrhotic portal hypertension (NCPH) is unknown. plasma ADM levels were studied in patients with NCPH, compensated and decompensated cirrhosis in order to determine its contribution to portal hypertension (PH) in these groups.

METHODS

There were 4 groups of subjects. Group 1 consisted of 27 patients (F/M: 12/15) with NCPH due to portal and/or splenic vein thrombosis (mean age: 41+/-12 years), group 2 consisted of 14 patients (F/M: 6/8) with compensated (Child-Pugh A) cirrhosis (mean age: 46+/-4), group 3 consisted of 16 patients (F/M: 6/10) with decompensated (Child-Pugh C) cirrhosis (mean age: 47+/-12). Fourteen healthy subjects (F/M: 6/8) (mean age: 44+/-8) were used as controls in Group 4. ADM level was measured by ELISA. NO was determined as nitrite/nitrate level by chemoluminescence.

RESULTS

ADM level in Group 1 (236+/-61.4 pg/mL) was significantly higher than that in group 2 (108.4+/-28.3 pg/mL) and group 4 (84.1+/-31.5 pg/mL) (both P<0.0001) but was lower than that in Group 3 (324+/-93.7 pg/mL) (P=0.002). NO level in group 1 (27+/-1.4 micromol/L) was significantly higher than that in group 2 (19.8+/-2.8 micromol/L) and group 4 (16.9+/-1.6 micromol/L) but was lower than that in Group 3 (39+/-3.6 micromol/L) (for all three P<0.0001). A strong correlation was observed between ADM and NO levels (r=0.827, P<0.0001).

CONCLUSION

Adrenomedullin and NO levels were high in both non-cirrhotic and cirrhotic portal hypertension and were closely correlated, Adrenomedullin and NO levels increased proportionally with the severity of cirrhosis, and were significantly higher than those in patients with NCPH. Portal hypertension plays an important role in the increase of ADM and NO. Parenchymal damage in cirrhosis may contribute to the increase in these parameters.

摘要

目的

肾上腺髓质素（ADM）是一种强效血管舒张肽。ADM和一氧化氮（NO）在血管内皮细胞中产生。ADM水平升高与肝硬化门静脉高压（CPH）时的高动力循环和动脉血管舒张有关。ADM在非肝硬化门静脉高压（NCPH）中的作用尚不清楚。本研究检测了NCPH患者、代偿期和失代偿期肝硬化患者的血浆ADM水平，以确定其在这些人群门静脉高压（PH）中的作用。

方法

研究对象分为4组。第1组由27例因门静脉和/或脾静脉血栓形成导致NCPH的患者组成（男15例，女12例）（平均年龄：41±12岁），第2组由14例代偿期（Child-Pugh A级）肝硬化患者组成（男8例，女6例）（平均年龄：46±4岁），第3组由16例失代偿期（Child-Pugh C级）肝硬化患者组成（男10例，女6例）（平均年龄：47±12岁）。第4组为14名健康受试者（男8例，女6例）（平均年龄：44±8岁）作为对照组。采用酶联免疫吸附测定法（ELISA）检测ADM水平。通过化学发光法将NO测定为亚硝酸盐/硝酸盐水平。

结果

第1组ADM水平（236±61.4 pg/mL）显著高于第2组（108.4±28.3 pg/mL）和第4组（84.1±31.5 pg/mL）（P均<0.0001），但低于第3组（324±93.7 pg/mL）（P = 0.002）。第1组NO水平（27±1.4 μmol/L）显著高于第2组（19.8±2.8 μmol/L）和第4组（16.9±1.6 μmol/L），但低于第3组（39±3.6 μmol/L）（三组P均<0.0001）。ADM水平与NO水平之间存在强相关性（r = 0.827，P<0.0001）。