Clincal Correlation Study Of Plasma Adrenomedullin And Cirrhosis Of Hepatitis B

BACKGROUND cirrhosis is one of the common diseases in China and HBV infection is the main cause of it. The yearly incidence of decompensated cirrhosis is estimated 3% and the 5-year mortality of compensated and decompensated cirrhosis in chronic hepatitis B are 14%-20% and 70%-86%, respectively. Kinds of potent vasoactive substances such as endothelin (ET) , Nitric Oxide (NO) , vasoactive intestinal polypeptide (VIP) have been found to be correlated with cirrhosis and portal hypertension, but not a theory could interpret the hyperdynamic circulation of cirrhosis completely. Adrenomedullin (ADM) is a potent vasodilator peptide which has been found to be obvious correlation with cardiovascular diseases, renal diseases and many other diseases. Some animal experiments are also indicating that ADM may be related to hepatic stellate cell (HSC) activation and hyperdynamic circulation. However, little is known about the role of adrenomedullin in this condition.AIM To evaluate plasma levels of adrenomedullin (ADM) in patients with compensated and decompensated cirrhosis because of hepatitis B virus, to investigate the correlation between ADM and cirrhosis and the pathogenesis of portal hypertension, and to find the theory bases of better treating cirrhosis.METHODS Plasma adrenomedullin concentrations were measured by radioimmunoassay (RIA) in cirrhotic patients, decompensation cirrhotic, CHB and healthy subjects. Endothelin (ET) , Nitric Oxide (NO), Liver function, prothrombin activity(PTA), HBVDNA and the width of portal vein were tested at the same time. CHB patients and healthy subjects were considered to be control groups.RESULTS 1. Plasma ADM levels in cirrhotic patients were significantly higher than those in CHB patients and healthy subjects (p<0.05) In patients with decompensation, the levels were higher than those in non-decompensated cirrhotic patients (p<0.05) and no significant differences were found between CHB patients and healthy subjects(p>0.05).2. In cirrhotic patients, ET and NO levels were significantly higher than those in other groups and correlated positively with ADM levels (r= 0.828 p<0.05, r=0.753 p<0.05, respectively.)3. ADM levels were significantly higher in cirrhotic patients of albumin≤35g/l, PTA≤60%, Total bilirubin(TBIL)≥50umol/L, and the width of portal vein≥14mm.4. ADM levels had significant positive correlations with Total bilirubin(TBIL) and the width of portal vein (r=0.673,-0.452, p<0.05, respectively.) but negative correlations with albumin and prothrombin time activity (r=-0.510,p<0.05) in cirrhotic patients. There were no significant correlations between ADM and ALT, cholesterol, PTA, and HBVDNA levels in cirrhotic patients(r=0.162,-0.332,-0.278,p<0.05 respectively.) .CONCLUSIONS Plasma adrenomedullin concentrations elevate with the progression of liver cirrhosis . ADM levels have significant correlations with Total bilirubin, albumin and prothrombin time activity , and no significant correlations between ADM and ALT, cholesterol, PTA, and HBVDNA levels in cirrhotic patients. There are significant correlations between plasma adrenomedullin and liver fibrosis. ADM levels have significant correlations with ET and NO levels and the width of portal vein. Elevated adrenomedullin may participated in the regulation of portal hypertension with other potent vasoactive substances' interreaction. D etection the level of ADM in patients of chronic liver diseases may be useful for the diagnosis of cirrhosis and portal hypertension.