Clinical Study Of Angintensin Ⅱ Receptor Blocker Irbesartan Against Hepatic Fibrosis

Background and Aims:Hepatic fibrosis is an important pathological feature of chronic liver disease,and is also one of the essential evolutive process of hepatic cirrhosis.It has found that angiotensinⅡhas been provided with the characteristic of growth factor and promote fibrosis factor in recent years.The angiotensinⅡplay an important role in the occurrence of liver fibrosis, heart and kidney.Animal experiments had been shown that angiotensinⅡreceptor blocker could inhibit and reduce the degree of fibrosis of those organs.The present study observed effection on chronic hepatitis and decompensated hepatic cirrhosis in patients with oral angiotensinⅡreceptor blocker Irbesartan,in order to probe into its mechanism of anti-liver fibrosis in clinical efficacy and offer the evidence for clinical applications.Materials and Methods:The data had been collected 60 cases of patients with chronic hepatitis B or C,alcoholic hepatitis,or decompensated liver cirrhosis from April 2008 to March 2009 hospitalized. Enrolled all patients were randomly divided into two groups,the 30 cases of patients as a control group were treated with conventional hepatoprotective drugs.The otherwise 30 cases of patients as a experimental group were added Irbesartan 150mg/d,oral,and conventional hepatoprotective drugs same as a control group.Overall therapy time was a 4 month.Both groups were measured the diameter of portal vein(DPV) and splenic vein(DSV) by color Doppler ultrasonography before and after 4 month treatment.Meanwhile the liver function, platelet(PLT),prothrombin time(PT) and the serum makers of liver fibrosis amino terminal procollagen typeⅢpeptide(PⅢP),hyaluronic acid(HA),laminin fragment(LN) and typeⅣcollagen(CⅣ) for studied two groups were examinated.The experimental results were analyzed by the statistics.Results:1.The levels of angiotensinⅡand aldosterone in the control group were not changed before and after treatment(P＞0.05).But the level ofangiotensinⅡwas significantly increased and the level of aldosterone was significantly reduced in the experimental group after treatment. The experimental group were significantly different compared with those of the control group (P＜0.05).2.The surm levels of PⅢP,HA,LN and CⅣin the two groups could been decreased after treatment.Irbesartan significantly reduced the surm levels of PⅢP,HA,LN and CⅣ.There was significant difference between the experimental group and the control group after treatment(P＜0.05).3.The surm levels of ALT,AST,GGT,AST/ALT of the two groups could been decreased and the surm levels of ALB,A/G manifested increasing after treatment.They were significantly different compared with those before treatment(P＜0.05).The experimental group on levels of ALT,AST,GGT,AST/ALT was significantly decreased compared with those of the control group(P＜0.05),but there were not differentce in two groups on the levels ofALB,A/G(P＞0.05).4.The level of PLT was not changed significantly after treatment and the level of PT could been significantly shortened in the two groups after treatment,which were not significantly difference compared the experimental group witht the control group(P＞0.05).5.The diameter of portal vein and splenic vein of the two groups could be dwindle after treatment.It was significantly different compared the experimental group witht the control group(P＜0.05).Conclusion:1.The Irbesartan of angiotensinⅡreceptor blocke could change the levels of angiotensinⅡand aldosterone,inhibit the activity of renin-angiotensin system.2.The levels of PⅢP,HA,LN and CⅣas a direct serum makers of liver fibrosis could been decreased by Irbesartan.The levels of liver fibrosis ALT,AST,GGT,AST/ALT as a indirect serum makers were decreased significantly by Irbesartan.However,there was no significant difference in some of the indirect serum makers ALB,A/G,PLT,PT between two groups after treatment.3.Irbesartan could significantly dwindle DPV and DSV.It was suggested AngiotensinⅡreceptor blocker could reduce the pressure of portal vein to improve the liver circulation and recover liver function and inhibit hepatic fibrosis progress.4.The Irbesartan of angiotensinⅡreceptor blocker was shown effectively in anti-hepatic fibrosis with chronic hepatitis B or C,alcoholic hepatitis or decompensated liver cirrhosis.