Adrenomedullin, a Vasodilator Peptide Implicated in Hemodynamic Alterations of Liver Cirrhosis Relationship to Nitric Oxide
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This prospective cohort study was aimed atinvestigating the role of adrenomedullin, a potentvasodilator peptide, in liver cirrhosis and itsrelationship with nitric oxide and cytokines. Overall,66 consecutive patients with liver cirrhosis and 15 controlsmatched for age and sex distribution were included.Adrenomedullin levels in patients with cirrhosis werehigher than in controls [28.1 (23.5-34.8) vs 21.9 (21.1-26.4) pmol/liter, P = 0.002]. Child classA patients had adrenomedullin levels similar to those ofcontrols, but lower than patients in class B and C,respectively (P = 0.01). Patients with ascites showed more elevated adrenomedullin levels thanpatients without (P = 0.001). Adrenomedullin levels hadsignificant correlations with aldosterone (r = 0.55; P< 0.001), plasma renin activity (r = 0.49; P < 0.001) and nitrates-nitrites levels (r= 0.52; P < 0.001). Weak correlations were found withtumor necrosis factor-alpha and interleukin-6. Thisstudy shows that high levels of adrenomedullin in liver cirrhosis correlate with featuresassociated with plasma volume expansion, and suggeststhat, in late stages of cirrhosis, adrenomedullin mightcontribute to vasodilatation by increasing thegeneration of nitric oxide.
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