Liver, Pancreas, and Biliary TractIncreased adrenomedullin levels in cirrhosis: Relationship with hemodynamic abnormalities and vasoconstrictor systems☆,☆☆
Section snippets
Patients and methods
The present study included three protocols approved by the Investigation and Ethics Committee of the Hospital Clínic i Provincial of Barcelona. Informed consent was obtained from each subject studied. All subjects included were studied after 6 days on a 40-mEq/day sodium diet. In cirrhotic patients, diuretics were withdrawn during the same period.
Circulating levels of AM in patients with cirrhosis: Relationship with systemic hemodynamics, renal function, and vasoactive factors
Table 1 shows the demographic data and liver and renal function test results in the three groups of subjects.
Empty Cell Healthy subjects (n = 17) Cirrhotics without ascites (n = 9) Cirrhotics with ascites (n = 25) P value (ANOVA) Sex (M/F) 11/6 8/1 16/9 NS Age (yr) 51 ± 6 59 ± 5 58 ± 2 NS Etiology of cirrhosis (viral/alcohol) — 5/4 12/13 NS Serum bilirubin (mg/dL) 0.7 ± 0.1 1.6 ± 0.2a** 6.8 ± 2a**,b** <0.001 Serum albumin (g/L) 47 ± 1 34 ± 2a*** 27
Discussion
Under physiological conditions, AM is mainly synthetized in vascular tissue, adrenal medulla, heart, lungs, and kidneys.25, 26, 27, 28, 29 The greatest expression of AM messenger RNA has been found in endothelial cells.30 Moreover, endothelial cells in culture secrete AM constitutively in a manner similar to the vasoconstrictor peptide endothelin.30 The main biological effect of AM is vascular relaxation. Administration of AM to experimental animals is associated with arterial hypotension,
Acknowledgements
The authors thank Raquel Cela, R.N., Carme Escofet, R.N., and Núria Pons, R.N., for expert technical assistance and the nursing staff of the Liver Unit for their help.
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Supported by grant FIS/97/2073 from the Fondo de Investigaciones Sanitarias and Dirección General de Investigación Científica y Técnica (SAF96-0131 and SAF96-0082); a grant from the Fundació Clínic per la Recerca Biomèdica (to M.G.); grant 96/1723 from the Fondo de Investigación Sanitaria (to G.F-E.); a fellowship grant from the Hospital Clínic i Provincial of Barcelona (to P.S.); and a fellowship grant from the Comisió Interdeparta mental de Recerca i Innovació Tecnològica (to R.B.).
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Address requests for reprints to: Pere Ginès, M.D., Liver Unit, Hospital Clínic i Provincial, Villarroel 170, 08036 Barcelona, Spain. Fax: (34) 3-451-52-72.