Львівський клінічний вісник (Dec 2015)
Content of Some Endothelium-Dependent Vasoactive Substances of Blood Plasma, Indicators of Renin-Aldosterone System, Natriuretic Hormone in Patients with Decompensated Liver Cirrhosis and their Dependence on the Severity Grade of Portal Hypertension
Abstract
Introduction. Liver cirrhosis is one of the most important and most difficult problems of modern hepatology. According to the statistics, each year liver cirrhosis kills nearly two million people. The question of the relationship of endothelial dysfunction as a vasoconstrictor and vasodilator imbalance, indices of renin-aldosterone system and natriuretic hormone in the blood of the portal system in patients with liver cirrhosis, their importance in the origin and growth of the severity of portal hypertension caused great interest of the specialists of hepatological profile, and sometimes serve as the subject of stormy scientific discussions with the wording ambiguous and sometimes contradictory conclusions. Today we know that endothelial dysfunction is the factor of portal hypertension origin, but the dynamics of plasma concentrations of endocrine regulators, their role in the increase of the severity of portal hypertension are still not fully studied. Despite the high prevalence of the study of pathogenic mechanisms, searching the main “markers” of the severity of liver disorder and their role in the increase of the disease decompensation in patients with liver cirrhosis, the content of endothelium-dependent vasoactive substances of blood plasma, parameters of renin-aldosterone system, natriuretic hormone in patients with decompensated liver cirrhosis, particularly with varying grades of portal hypertension, are studied insufficiently. Therefore, the aim of our study was to determine the content of some endothelium-dependent vasoactive substances of blood plasma, parameters of renin-aldosterone system, natriuretic hormone in patients with decompensated liver cirrhosis and to identify their dependence on the severity of portal hypertension grade. Materials and research methods. In the study, by randomized method with preliminary stratification, were involved 80 cirrhotic patients with varying severity grades of portal hypertension [23 females (28.75 %) and 57 males (71.25%) aged 27 to 73 years (mean age – ( 47,5 ± 10,9) years), mean duration of disease – (6,5 ± 2,7) years], to whom were conducted inpatient examination and treatment in created Lviv Regional Hepatological Center on the basis of the Department of Internal Medicine N 1 of Danylo Halytsky Lviv National Medical University and Gastroenterological Department of Lviv Regional Clinical Hospital. Also there were examined 20 healthy individuals [8 females (40.0 %) and 12 males (60.0 %)) aged 19 to 70 years (mean age – 41,8 ± 4,2 years)], who formed the control group. For all the patients it was performed a comprehensive clinical-laboratory and instrumental examination of all the organs and systems according to the requirements of modern medicine and improved by us doppler-floumetric ultrasound examination of the abdominal cavity vessels, using our patented method. With the aim to study the contents of some endothelium-dependent vasoactive substances, indices of renin-aldosterone system and natriuretic hormone of blood plasma in patients with decompensated liver cirrhosis, we determined the levels of endothelin-1, cyclic guanosine monophosphate, tumor necrotizing factor α, renin, aldosterone and natriuretic hormone – according to the standardized methodology. According to the results of non-invasive ultrasound dopler-floumetric examination of the abdominal cavity vessels and determining the severity of portal hypertension grade, all the patients were stratified into three groups: the 1st group (portal hypertension of the I grade) included 20 patients (25.0%), the 2nd group (portal hypertension of the II grade) – 30 patients (37.5 %) and the 3rd group (portal hypertension of the III grade) – 30 patients (37.5 %). Results of the investigation and their discussion. According to the results of our study, we can observe the dynamics tendency of the content of endothelium-dependent vasoactive substances, indices of renin-aldosterone system, natriuretic hormone of blood plasma in patients with decompensated liver cirrhosis and their dependence on the severity of portal hypertension grade. In patients with decompensated liver cirrhosis there were observed intense increase of endothelin-1, cyclic guanosine monophosphate, tumor necrotizing factor α, renin, aldosterone and natriuretic hormone compared with the reference rates (p < 0.05), which allows us to consider them as one of the “markers” of the severity of chronic diffuse liver disease. Growth of the level of endothelium-dependent vasoactive substances, indices of renin-aldosterone system, natriuretic hormone in the blood plasma of patients are directly proportional to the severity of portal hypertension grade. This fact indicates, that they are the pathogenetic link in origin and play a key role in the increase of the severity of the leading syndrome of portal hypertension, which causes the worsening of the general state of these patients, leads to a significant decrease of life quality and its complications, including bleeding from varicose esophageal varices, are of the decisive prognostic value and is the leading cause of death of the hepatological patients. Conclusions. In patients with decompensated liver cirrhosis the content of endothelium-dependent vasoactive substances of blood plasma, parameters of the renin-aldosterone system, natriuretic hormone were significantly higher (p < 0.05), compared with the reference indices, that can be considered as one of the “markers” of the severity of chronic diffuse liver diseases. Growth of the content of endothelin-1, cyclic guanosine monophosphate, tumor necrotizing factor α, renin, aldosterone and natriuretic hormone in the blood plasma of patients was directly proportional to the severity of portal hypertension diagnosed using noninvasive ultrasound doppler-floumetric improved examination of the vessels of the abdominal cavity, improved by us. Determination of the concentration levels of endothelin-1, cyclic guanosine monophosphate, tumor necrotizing factor α, renin, aldosterone and plasma natriuretic hormone in patients with decompensated liver cirrhosis can serve as a reliable diagnostic subsidiary criteria for the detection of portal hypertension and as one of “markers” of the determination of its severity grade.
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