The Changes And Clinical Role Of Plasma ADM And ET-1 In Cirrhosis Patients With Portal Hypertension

Objective: to study the the changes and clinical role of vascular active substances ADM and ET - 1 in Cirrhosis patients with portal hypertensionMethods: 39 liver cirrhosis patients were investigated, including 19 cases with bleeding history, 26 cases with ascites formation , 20 healthy person as controls. The plasma concentrations of ADM and ET– 1 were investigated,Meanwhile we detected the hemodynamic index of portal and spleen vein by color doppler,such us maximum flow velocity and inner diameter of portal vein (PV) and spleen vein(SV). The blood flow volume and congestion index(CI) of them were calculated .Results: 1. Plasma level of ADM in liver cirrhosis patients was higher,while ET-1 levels was significantly decreased.The blood flow velocity of portal vein (VPV) and spleen vein (VSV) droped, while SV flow volume(QSV), the ratio of SV to PV flow volume ( QSV/ QPV) ,PV congestion index(PVCI) and SV congestion index (SVCI) were significantly higher in cirrhotic group .Though QPV is higher than the average level of normal person, it was not statistically significant. 2. The plasma level of ADM was highter and ET-1 levels was lower in cirrhosis patients with bleeding history than that with no bleeding history, but it was not statistically significant. The QPV and VPV decreased, while the QSV , QSV/ QPV,VSV and PVCI increased with statistical significance. 3. Plasma concentration of ADM was significantly higher and ET-1 levels was lower in 26 cirrhosis with ascites formation than patients with no ascites formation significantly .The QSVand SVCI increased with statistical significance,while the QPV and PVCI increased, VPVand VSV decreased with no statistical significance . 4. ADM level was positively correlated with QSV,QSV/ QPV and SVCI. while ET - 1 was negatively correlated with them. But they were unrelated with QPV,VPV, VSV,and PVCI. Conclusion: 1. The Plasma concentration of vascular active substances was abnormal in liver cirrhosis. Plasma ADM and ET - 1 participated in the formation and progress of portal hypertension. They were correlated to high dynamic of spleen vein (SV) and were uncorrelated to hemodynamic changes of portal vein(PV). 2. The concentration changes of plasma ADM and ET - 1 had certain relevance to ascites formation. It indicated the metabolism disorder of vaso-active substances in cirrhosis patients play an important role in ascites formation . 3. ADM and ET - 1 had no predictive value of hemorrhage; Doppler ultrasound parameters could indirectly reflect the pressure of gastric and esophageal varices. So, dynamic observation of them could have predictive value of bleeding.