A Study on the Changes of Plasma Endothelin-1 and the Vasoactive Hormones in Patients with Liver Cirrhosis Before and After Control of Acites

Lee, Jin; Kang, Seung Sik; Park, Cheol Soo; Park, Woo Jeong; Lee, Kwon Yeop; Kae, Sea Hyub; Kwak, Sang Taek; Joo, Sang Aun; Kim, Ho Joong; Kee, Choon Suhk

Abstract

BACKGROUND AND AIMS: The purpose of the present study was to clarify the possible correlation of endothelin-1 with other vasoactive neurohormonal activities and its effects on fluid-electrolytes balance and renal function in ascitic patients with liver cirrhosis after control of ascites.
METHODS
The plasma concentration of endothelin-1 (PET-1) was measured by specific radioimmunoassay with simultaneous measurement of serutn sodium concentration, serum albumin and other blood chemistries, renal functions with creatinine clearance, urinary sodium excretion, plasma renin activity, plasma aldosterone and plasma norepinephrine in 35 patients with liver cirrhosis with (n=19) and without (n=16) ascites. The same measurements were repeated on the 8th day of admission after control of ascites.
RESULTS
The PET-1 in ascitic group was significantly increased from 16.4+/-10.6 pg/mL to 26.6+/-16.8 pg/mL after conventional therapy of ascites for 7 days, but not in the non-ascitic group. After control of ascites, plasma renin activity (PRA) (from 5.4+/-3.3 to 8.6+/-5.0 ng/mL/hr), plasma aldosterone (frorn 238+/-197 to 313+/-239 pg/mL) and norepinephrine (from 714+/-162 to 814+/-226 pg/mL) concentrations were significantly increased in ascitic group (p=0.003, p=0.014, p=0.001). The PET-1 showed a significant negative correlation with serum sodium (R= -0.75, P=0.0001), creatinine clearance (R=-0.52, P=0.0012) and 24-hour urinary sodium excretion (R=-0.63, p=0.0000) after therapy for ascites. The PET-1 was significantly correlated with PRA (R=0.69, p=0.000), plasma aldosterone (R=0.67, p=0.000) and norepinephrine (R=0.62, p=0.000) concentrations.
CONCLUSIONS
These results suggest that conventional therapy for ascites with diuretics or paracentesis in decompensated liver cirrhosis induces the decrease of effective circulatory volurne and increase of PET-1 which is well correlated with other vasoactive hormones inducing renal dysfunction and sodium-free water retention.