Clinical Significance Of Portal Hemodynamics And Plasma Vasoactive Substances Levels In Cirrhotic Patients

Liver cirrhosis is common in clinic. Esophageal variceal bleeding (EVB) is one of the most important complications of cirrhosis that result from portal hypertension. The fatality rate of EVB is about 39%-54%. Therefore it is important to investigate the pathogenesis and diagnostic methods of portal hypertension and to search for prediction index for EVB.Objective: To investigate the value of application of Color Doppler Ultrasound and vasoactive substances in the diagnosis of portal hypertension and prediction for EVB.Methods: The maximal diameters, mean flow velocity and flow rate of the portal vein (PV) and splenic vein (SV) were detected with Color Doppler Ultrasound. We assayed the plasma levels of ET-1, CGRP and NO with radioimmunoassay and biochemical methods.Results:1. The PVD, PVF, PVCI and SVD, SVF, SVCI were significantly higher incirrhotic patients than that in controls ( P<0.01 ). However, the PVV were lower in patients than that in controls significantly ( P<0.01 ).2. If the patients were divided into three groups as A, B and C according Child-Pugh grade, the PVD and PVCI were significantly higher in group C than that in group A and B ( P<0.01 ), the PVV in group C were significantly lower than that in group A (P<0.05 ).3. If the patients were divided into two groups as EV (+) and EV (-), the EV (+) group had significant higher PVD, PVCI (P<0.01) and SVCI (P<0.05) compared with the EV (-) group. The PVV and PVF were significantly lower in EVB (+) group than that in EV (-) group (P<0.01, P<0.05).4. The PVD, PVCI and SVCI were higher in EVB (+) patients than that in EVB (-) patients significantly (P<0.01, P<0.05). At the same time, the PVV and SVV were significantly lower in EVB (+) patients than that in EVB (-) patients (P<0.01, P<0.05).5. The plasma levels of ET-1, CGRP and NO were significantly higher in patients than that in controls. Their plasma levels were increased in relation to the severity of hepatic function impairment as assessed by Child-Pugh grade.6. Plasma levels of ET-1, CGRP and NO were correlated with PVD, SVD and SVF positively (P<0.01). Plasma levels of ET-1 and NO had negative correlation with PVV (P<0.05, P<0.01).7. Plasma levels of ET-1 and NO were higher significantly in EVB (+) patients than that in EVB (-) patients (P<0.01). According Logistic regression, decrease of SVV and increase of plasma level of ET-1 were risk factors for EVB.Conclusion: There were splanchnic hyperdynamics and portal hyper resistance in cirrhotic patients. The condition of portal hemodynamics was influenced partly by liver function. Color Doppler Ultrasound and plasma levels of vasoactive substances may have some diagnostic values in portal hypertention. Detection of portal hemodynamics and vasoactive substances was promising in prediction for EVB.