Brief Reports Open Access
Copyright ©The Author(s) 2001. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 15, 2001; 7(1): 126-127
Published online Feb 15, 2001. doi: 10.3748/wjg.v7.i1.126
Plasma endothelin in patients with endotoxemia and dynamic comparison between vasoconstrictor and vasodilator in cirrhotic patients
Feng Liu, Ji Xin Li, Chun Mei Li, Xi Sheng Leng
Feng Liu, Department of General Surgery, the Fifth Affiliated Hospital, Harbin Medical University, Harbin 150036, Heilongjiang Province, China
Ji Xin Li, Chun Mei Li, Xi Sheng Leng, Department of General Surgery, People’s Hospital, Medical University, Beijing 100044, China
Feng Liu, graduated from Beijing Medical University as a postgraduate in 1995, now associate professor of general surgery, majoring hepatobilliary surgery, having 12 papers published.
Author contributions: All authors contributed equally to the work.
Supported by the National Natural Science Foundation and Ministry of Public Health of China, No.37600481
Correspondence to: Dr. Feng Liu, Department of General Surgery, the Fifth Affiliated Hospital, Harbin Medical University, Harbin 150036, Heilongjiang Province, China.
Telephone: 0086-51-5314098 Fax: 0098-51-5314088
Received: July 26, 2000
Revised: September 22, 2000
Accepted: September 29, 2000
Published online: February 15, 2001

Key Words: hypertension, portal, liver cirrhosis, portosystemic shunt, surgical, endothelins, radioimmunoassay, epoprostenol, liver cirrhosis


Portal hypertension is a common clinical syndrome characterized by an abnormal increase in portal blood to the systemic circulation, bypassing the liver. Recent studies have reported that humoral substances play an important role in the pathogenesis of portal hypertension, either by increasing vascular resistance at both the intrahepatic and porto-collateral sites or affecting splanchnic vasodilation with a concomitant increase in parto-collateral blood flow[1-6].

Endothelin (ET) released by endothelial cells is a 21-amino acid peptide with potent vasoconstrictor action. Endothelin comprises a family of four homologous isopeptides in human and animals (ET-1, ET-2, and ET-3, VIC)[7-14]. Most reported data are related to ET-1, which is the most powerful vasoconstrictor. Owing to a variety of reasons, reports concerning endothelin levels in cirrhotics are not consistent with each other. Endothelin concentrations in plasma have been reported to be increased in some studies and normal or reduced in others[15-20]. Present evidence suggests that endothelin may play an important role in modulating intrahepatic vascular resistance[21-24]. However, the relationship between vasoconstrictor (ET, TX-) and vasodilator (PGI2) during portosystemic shunt has not been documented.


We measured the concentration of endothelin in plasma using radioimmunoassay in 121 patients with cirrhosis and compared these values with 50 age- and sex-matched control subjects, and evaluated systemic endotoxemia. At the same time, perioperative plasma vasoconstrictor and vasodilator were clinically observed in 30 portohypertensive cirrhotic patients undergoing portosystemic shunt.


Plasma endothelin levels were higher in cirrhotic patients with ascites than in those without ascites. Femoral venous plasma endothelin levels averaged 90 ± 23 ng/L in cirrhotic patients versus 34 ± 8 ng/L in controls (P = 0.000), and that of cirrhotics with ascites was higher than those without 106 ± 17 ng/L vs 90 ± 23 ng/L (P = 0.002). Moreover, plasma endothelin levels increased in proportion to the severity of endotoxemia (rs = 0.61, P = 0.034). Both the levels of plasma vasoconstrictors (ET, TX-) and of the vasodilator (PGI2) were higher in portohypertensive cirrhotic patients (ET: 107.8 ± 25.9 ng/L vs 48.1 ± 9.4 (P = 0.000); TX-: 349.7 ± 198.4 ng/L vs 156.3 ± 54 (P = 0.000); PGI2: 463.1 ± 108.3 ng/L vs 227.2 ± 46 (P = 0.000), and their concentrations decreased significantly in patients after portosystemic shunt (P = 0.002).


These results suggest that endothelin has significant influence on the portal vascular resistance of cirrhotic liver in vivo and may play an important role in the pathogenesis of portal hypertension[25-28]. Endotoxin may lead to the increased synthesis and release of endothelin. It could be that a dynamic balance between levels of vasoconstrictor and vasodilator in plasma exists in the pathophysiology of portohypertensive cirrhotic patients after portosystemic shunt.


Edited by Jason Carr

1.  Boyer TD. Portal hypertensive hemorrhage: pathogenesis and risk factors. Semin Gastrointest Dis. 1995;6:125-133.  [PubMed]  [DOI]  [Cited in This Article: ]
2.  Zhang ZY, Ren XL, Yao XX. Alterations and relationship of plasma endotoxin and nitric oxide in patients with cirrhosis. Xin Xiaohuabingxue Zazhi. 1997;5:369-370.  [PubMed]  [DOI]  [Cited in This Article: ]
3.  Yu Y, Tian HM, Shi ZG, Yao YM, Wang YP, Lu LR, Yu Y, Chang GY, Ma NS, Sheng ZY. Relationship between endotoxemia and dysfunction of intestinal immunoa-barrier after scald in rats. Huaren Xiaohua Zazhi. 1998;6:703-704.  [PubMed]  [DOI]  [Cited in This Article: ]
4.  Chen S, Liu B, Cai XM, Gu CH. Clinical significance of changes of endothelin and nitric oxide levels in peripheral blood of patients with severe hepatitis. Shijie Huaren Xiaohua Zazhi. 1999;7:122-124.  [PubMed]  [DOI]  [Cited in This Article: ]
5.  Assy N, Paizi M, Gaitini D, Baruch Y, Spira G. Clinical implication of VEGF serum levels in cirrhotic patients with or without portal hypertension. World J Gastroenterol. 1999;5:296-300.  [PubMed]  [DOI]  [Cited in This Article: ]
6.  Huang YQ, Xiao SD, Zhang DZ, Mo JZ. Nitric oxide synthase distribution in esophageal mucosa and hemodynamic changes in rats with cirrhosis. World J Gastroenterol. 1999;5:213-216.  [PubMed]  [DOI]  [Cited in This Article: ]
7.  Wang JY, Wang XL, Liu P. Detection of serum TNF-alpha,IFN-beta,IL-6 and IL-8 in patients with hepatitis B. World J Gastroenterol. 1999;5:38-40.  [PubMed]  [DOI]  [Cited in This Article: ]
8.  Xu KD, Liu TF, Cing X. Significance of detection of plasma nitric oxide, endothelin, endotoxin in patients with liver cirrhosis. World J Gastroenterol. 1998;4:64.  [PubMed]  [DOI]  [Cited in This Article: ]
9.  Liu ZH. Clinical study of therapeutic effect of dong fang gan kang no.1 on fatty liver. World J Gastroenterol. 1998;4:73.  [PubMed]  [DOI]  [Cited in This Article: ]
10.  Xu YJ, Liu XN, Guan HW, Zhu LH, Bai DS. Diagnosis and treat-ment of spontaneous rupture of liver carcinoma with bleeding. World J Gastroentero. 1998;4:81.  [PubMed]  [DOI]  [Cited in This Article: ]
11.  Wu MC. Clinical research advances in primary liver cancer. World J Gastroenterol. 1998;4:471-474.  [PubMed]  [DOI]  [Cited in This Article: ]
12.  Yao XX, Cui DL, Sun YF, Li XT. Clinical and experimental study of effect of Raondix Salviae Militiorrhiza and other blood-activating and stasis-eliminating Chinese herbs on hemodynamics of portal hypertension. World J Gastroenterol. 1998;4:439-442.  [PubMed]  [DOI]  [Cited in This Article: ]
13.  Yu YY, Si CW, Tian XL, He Q, Xue HP. Effect of cytokines on liver necrosis. World J Gastroenterol. 1998;4:311-313.  [PubMed]  [DOI]  [Cited in This Article: ]
14.  Jia JB, Han DW, Xu RL, Gao F, Zhao LF, Zhao YC, Yan JP, Ma XH. Effect of endotoxin on fibronectin synthesis of rat primary cultured hepatocytes. World J Gastroenterol. 1998;4:329-331.  [PubMed]  [DOI]  [Cited in This Article: ]
15.  Yang JM, Han DW, Xie CM, Liang QC, Zhao YC, Ma XH. Endotoxins enhance hepatocarcinogenesis induced by oral intake of thioacetamide in rats. World J Gastroenterol. 1998;4:128-132.  [PubMed]  [DOI]  [Cited in This Article: ]
16.  Liu GS, Huang YX, Li SW, Pan BR, Wang X, Sun DY, Wang QL. Experimental study on mechanism and protection of stress ulcer produced by explosive noise. World J Gastroenterol. 1998;4:519-523.  [PubMed]  [DOI]  [Cited in This Article: ]
17.  Lu MD, YY W. A study of portal vein embolization with absolute ethanol injection in cirrhotic rats. World J Gastroenterol. 1998;4:415-417.  [PubMed]  [DOI]  [Cited in This Article: ]
18.  Assy N, Gong Y, Zhang M, Minuk G. Appearance of an inhibitory cell nuclear antigen in rat and human serum during variable degrees of hepatic regenerative activity. World J Gastroenterol. 1999;5:103-106.  [PubMed]  [DOI]  [Cited in This Article: ]
19.  Assy N, Minuk G. A comparison between previous and present histologic assessments of chronic hepatitis C viral infections in humans. World J Gastroenterol. 1999;5:107-110.  [PubMed]  [DOI]  [Cited in This Article: ]
20.  He P, Tang ZY, Ye SL, Liu BB. Relationship between expression of alpha-fetoprotein messenger RNA and some clinical parameters of human hepatocellular carcinoma. World J Gastroenterol. 1999;5:111-115.  [PubMed]  [DOI]  [Cited in This Article: ]
21.  Peng XM, Yao CL, Chen XJ, Peng WW, Gao ZL. Codon 249 mutations of p53 gene in non-neoplastic liver tissues. World J Gastroenterol. 1999;5:324-326.  [PubMed]  [DOI]  [Cited in This Article: ]
22.  Saitoh O, Sugi K, Lojima K, Matsumoto H, Nakagawa K, Kayazawa M, Tanaka S, Teranishi T, Hirata I. Increased prevalence of intestinal inflammation in patients with liver cirrhosis. World J Gastroenterol. 1999;5:391-396.  [PubMed]  [DOI]  [Cited in This Article: ]
23.  Li ZZ, Wei CD, Wang Y, Xing C, Guo H, Cai W, Liu H. The effect of cold upon upper gastrointestinal hemorrhage resulting from liver cirhosis and its mechanism. World J Gastroenterol. 1998;4:74.  [PubMed]  [DOI]  [Cited in This Article: ]
24.  Pan RM, Shao XD. Clinical characteristics of alcoholic liver disease. World J Gastroenterol. 1998;4:95-96.  [PubMed]  [DOI]  [Cited in This Article: ]
25.  We i H, Wang YX. Aclinic alanalysis of 36 cases of hepatopulmonary syndrome. World J Gastroenterol. 1998;4:101.  [PubMed]  [DOI]  [Cited in This Article: ]
26.  Gu SQ, Li LY, Li Z, He D. Analysis on clinical features of hepatic encephalopathy of 108 cases. World J Gastroenterol. 1998;4:101.  [PubMed]  [DOI]  [Cited in This Article: ]
27.  Wu CH. Fibrodynamics-elucidation of the mechanisms and sites of liver fibrogenesis. World J Gastroenterol. 1999;5:388-390.  [PubMed]  [DOI]  [Cited in This Article: ]
28.  Cheng ML, Wu YY, Huang KF, Luo TY, Ding YS, Lu YY, Liu RC, Wu J. Clinical study on the treatment of liver fibrosis due to hepatitis B by IFN-alpha(1) and traditional medicine preparation. World J Gastroenterol. 1999;5:267-269.  [PubMed]  [DOI]  [Cited in This Article: ]