ENDOTHELIN 1-21 SERUM LEVEL IN PATIENTS WITH LIVER CIRRHOSIS
Abstract:
Background: Endothelin plays a role in the pathology and severity of pulmonary hypertension
which affects liver cirrhosis patients, but its importance in the context of other physiopathological
modifications is not yet well defined.Objective: The assessment of the relationship between Endothelin
1-21 serum level and the presence and severity of pulmonary hypertension in patients with liver
cirrhosis. Materials and methods: Between January 2007 and December 2008, 37 patients with liver
cirrhosis (25 men), with an average age of 58.54 ± 9.01 years, diagnosed at Medicala III Clinic from
Cluj-Napoca by liver enzymes, immunologic and viral markers, abdominal ultrasound, superior
digestive endoscopy and/or liver biopsy, and a control group of 14 healthy subjects (4 men), with an
average age of 59 ± 9.85 years were included in the study. The etiology of liver cirrhosis was hepatitis C
for 29.73 % of the patients (11p) and alcohol for 45.94% (17p). Sixty seven percent of the patients were
part of Child-Pugh class A (25p). The evaluation of pulmonary hypertension (PAH) was done using
clinical examination, electrocardiogram and Doppler transthoracic echocardiography, performed in the
Cardiology-Rehabilitation Clinic from Cluj-Napoca. A single parameter was assessed using Doppler
transthoracic echocardiography – the systolic pressure in the pulmonary artery (PAPSs). PAPs value ≥
30 mmHg was considered suggestive for the diagnosis of PAH. According to PAPs value, the patients
were divided into 3 groups of pulmonary hypertension, as follows: mild PAH = 30 – 44 mmHg (14
patients); average PAH = 45 – 70 mmHg (12 patients); severe PAH > 70 mmHg (0 patients). Eleven
patients did not have PAH (PAPs < 30 mmHg). The serum level of 1-21 endothelin (ET1-21) was
measured for the all the patients in the cirrhosis and the control group, using the ELISA method (NV:
0.02 fmol/ml). For the statistical analysis, the t-Student test, χ² test and the Pearson correlation test were
used. Results: In the liver cirrhosis group, the average values of ET1-21 were significantly higher than
those in the healthy subjects group (1.90 ± 0.96 fmol/ml vs. 0.9 ± 0.07 fmol/ml, p<0.0001). The average
serum values of ET1-21 were higher for the patients with liver cirrhosis and PAPs> 45 mmHg
compared with those without pulmonary hypertension (2.02 ± 0.85 fmol/ml vs 1.92 ± 1.32 fmol/ml,
p=0.41), but the difference was statistically significant (2.02 ± 0.85 fmol/ml vs 0.9±0.07 fmol/ml,
p=0.0004) when compared to the values for the healthy subjects. In what concerns the severity of liver
cirhhosis, the distribution of ET1-21 values was as follows: Child-Pugh class A 1.87 ± 0.87 fmol/ml,
Child – Pugh class B 1.74 ± 0.26 fmol/ml, Child – Pugh class C 2.35 ± 1.89 fmol/ml . Conclusion: ET1-
21 serum levels were significantly higher in patients with liver cirrhosis, the highest values being
recorded in women. ET1-21 serum level was significantly higher in patients with liver cirrhosis and
PAH compared to healthy subjects, supporting the role of the endothelin in the pathogenesis of PAH.
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