Hepato-systemic gradient of carbon monoxide in cirrhosis

作者：Tarquini Roberto^*; Masini Emanuela; La Villa Giorgio; Mazzoccoli Gianluigi; Mastroianni Rosanna; Romanelli Roberto Giulio; Vizzutti Francesco; Arena Umberto; Santosuosso Ugo; Laffi Giacomo

来源：European Journal of Internal Medicine, 2012, 23(1): E14-E18.

DOI：10.1016/j.ejim.2011.10.008

• Liver cirrhosis
• Carbon monoxide
• Nitric oxide
• Hepatic vein
• Peripheral vein

Background and aims: Experimental data suggest that in liver cirrhosis splanchnic and systemic vasculature exhibit marked endothelial Carbon monoxide (CO) overproduction, while recent data demonstrated heme oxygenase (HO) hyperactivity in the liver of rats with cirrhosis. No data are so far available on CO levels in the hepatic veins of cirrhotic patients. We aimed at evaluating whether plasma CO levels differ between systemic (peripheral vein) and hepatic (hepatic vein) circulation in patients with viral cirrhosis with and without ascites. %26lt;br%26gt;Methods: We enrolled 31 consecutive non-smoking in-or outpatients with liver cirrhosis. We measured wedge (occluded, WHVP) and free hepatic venous pressures (FHVP) and hepatic-vein pressure gradient (HVPG) was the calculated. Plasma level of NO and plasma CO concentration were determined both in peripheral vein and in the hepatic vein in cirrhotics. %26lt;br%26gt;Results: In cirrhotic patients plasma CO levels were significantly higher in the hepatic vein (16.66 +/- 10.71 p. p. m.) than in the peripheral vein (11.71 +/- 7.00 p.p.m). Plasma NO levels were significantly higher in peripheral vein (97.02 +/- 21.11 mu mol/ml) than in the hepatic vein (60.76 +/- 22.93 mu mol/ml). %26lt;br%26gt;Conclusions: In patients with liver cirrhosis we documented a hepato-systemic CO gradient as inferred by the higher CO values in the hepatic vein than in the peripheral vein. In cirrhotic patients, CO and NO exhibit opposite behavior in the liver, while both molecules show increased values in the systemic circulation. It can be speculated that increased intra-hepatic CO levels might represent a counterbalancing response to reduced NO intrahepatic levels in human liver cirrhosis.

• 出版日期2012-1