REVIEW Vasopressin-independent mechanisms in controlling ...
The effect of vasopressin on indocyanine green elimination in patients with cirrhosis
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280 PRESI ~ 0 PRES2 P~ITIGEFIS ~ONG HBsAp CARRIERS: RELATION WITHVIRAL REPLI~TION ~D REACTIVATION IN #fTI-HBe PATIENTS. _H2,lbarra, l,Hora, J,Bartolml~, F.La Banda, JC,Porres, C.Hero~dez-Guio, V.Cirreno. Department of Gastroenterology, FundaciGn Jim~nez D;az. Madrid. GRAIN, The pre-S region of the HBU genomecodes the expression of two antigens different from the HBs~g: preSl (P39/GP42) and preS2 (GP33/GP36). The aim of the study was to analyze the presence of those antigens in the serum of HBV chronic carriers, in relation with the viral replication level. Thirty-two HO~g positive patients histologically diagnosed were included, and as control group 30 healthy subjects with normal liver function tests and negative to all HBV markers, In addition 16 anti-HBe positive patients followed during 21.6~13,5 months a who sutfered a viral reactivation (increase of OPT and reappearance of HG'V-[/~el), were also included. PreS[ and preS2 antigens were detected by R]A using polystyrene beads coated with anti-preSl or anti-preS2 (Dr. W. Gerlich, GGttingen) and zzaI-anti-HDs as tracer. All the controls were negative for preS] and preS2. Presence of both viral antigens was detected in 24 (7~/,,) out of the 32 patients included. The other 8 patients who resulted negative were anti-HBe positive, asymptomatic carriers. We found a good relation between preSI, preS2 and H~ replication, since the level of these antigenswas significantly higher in HBeAg, HBV-OIt~positive patients than in the rest (p(O.05) (Table). preSl (S/N) preS2 (S,'N) GROUP 1 (HBeAg +/HB'J-Oh~ ÷) 151.1 ~ 84.1 ° 62.9 ± 34.8" ] GROUP II (HBeAg ÷/HBV-OI~ -) 127.2 ~ 79.6~ 39.9 ± 26.2b I GROUP 111 (Anti-HBe +/ abnormal OPT) 66.6 ± 54.4 26.7 ± 19.9 °: p(O.OO5 GROUP IV (Anti-HBe +/ normal OPT) 0.8 ± 0.4 1,3 ± 0.4 b: p(O.05 ~ong anti-HBe + patients suffering a reactivation a significant increase of preSl and preS2 leve]swas observed concurring with GPT exacerbation and HGV-DIt~posltlvlty. After reactivation, the level of preS antigens returned to the basal values. ]n conclusion the detection of preSl and preS2 antigens in serum, is more frequent in those patientswhlt high viral replication. Furthermore. amonganti-HOe carriers with a viral reactivation, synthesis of preS antigens takes place again. 281 THE EFFECT OF VASOPRESSIN ON INDOCYANINE GREEN ELIMINATION IN PATIENTS WITH CIRRHOSIS S. ISLAM, F. BALLET, Y. CHRETIEN, R. POUPON. Service d'h~patologie, HGpital Saint-Antoine 75571 Paris Cedex 12 - France - Vasopressin (Vp) has both hemodynamic and metabolic effects on the liver. We have previously shown that intravenous administration of Vp to cirrhotics reduces the intrinsic hepatic clearance (Vmax/km) of Indocyanine green (ICG). This may be either due to reduction of Vmax by a direct metabolic effect of Vp on the exposed hepato- cytes or to the increase of apparent km by decreasing the fraction o£ hepatic blood flow wich perfuses the functional areas of the liver. In order to elucidate the mechanism for the reduction of clearance Vmax/km of ICG by Vp we studied in 10 cirrhotic patients its effect on first order hepatic clearance and Vmax, a flow independent parameter. Under Vp clearance of ICG was reduced from 4.07 ~ O.67 to 3-09- 0.53 ml/min/kg body weight (P< O.02), Vmax was not modified significantly + + . (42.23- 2/70 vs 40.67- 2.71 pg/mxn/kg body weight), calculated Kmwas zncreased ÷ + / from 9-59- 0.96 to 12.03- 1.17 pg/ml and the clearance Vmax/km was reduced from + + . . 4.95- O.72 to 3.82- O.59 ml/mzn/kg body wezght (P< 0.02). These data suggest that the reduction of the clearance Vmax/km of ICG by Vp is not due to a direct metabolic effect on the hepatocytes but probably results from a decrease of the functional hepatic blood flow. S146
Transcript of The effect of vasopressin on indocyanine green elimination in patients with cirrhosis
280 PRESI ~0 PRES2 P~ITIGEFIS ~ONG HBsAp CARRIERS: RELATION WITH VIRAL REPLI~TION ~D REACTIVATION IN #fTI-HBe PATIENTS. _H2,lbarra, l,Hora, J,Bartolml~, F.La Banda, JC,Porres, C.Hero~dez-Guio, V.Cirreno. Department of Gastroenterology, FundaciGn Jim~nez D;az. Madrid. GRAIN,
The pre-S region of the HBU genome codes the expression of two antigens different from the HBs~g: preSl (P39/GP42) and preS2 (GP33/GP36). The aim of the study was to analyze the presence of those antigens in the serum of HBV chronic carriers, in relation with the viral replication level.
Thirty-two HO~g positive patients histologically diagnosed were included, and as control group 30 healthy subjects with normal l iver function tests and negative to all HBV markers, In addition 16 anti-HBe positive patients followed during 21.6~13,5 months a who sutfered a viral reactivation (increase of OPT and reappearance of HG'V-[/~el), were also included.
PreS[ and preS2 antigens were detected by R]A using polystyrene beads coated with anti-preSl or anti-preS2 (Dr. W. Gerlich, GGttingen) and zzaI-anti-HDs as tracer.
All the controls were negative for preS] and preS2. Presence of both viral antigens was detected in 24 (7~/,,) out of the 32 patients included. The other 8 patients who resulted negative were anti-HBe positive, asymptomatic carriers.
We found a good relation between preSI, preS2 and H~ replication, since the level of these antigens was significantly higher in HBeAg, HBV-OIt~ positive patients than in the rest (p(O.05) (Table).
preSl (S/N) preS2 (S,'N)
GROUP 1 (HBeAg +/HB'J-Oh~ ÷) 151.1 ~ 84.1 ° 62.9 ± 34.8" ] GROUP II (HBeAg ÷/HBV-OI~ -) 127.2 ~ 79.6 ~ 39.9 ± 26.2 b
I GROUP 111 (Anti-HBe +/ abnormal OPT) 66.6 ± 54.4 26.7 ± 19.9 °: p(O.OO5 GROUP IV (Anti-HBe +/ normal OPT) 0.8 ± 0.4 1,3 ± 0.4 b: p(O.05
~ong anti-HBe + patients suffering a reactivation a significant increase of preSl and preS2 leve]swas observed concurring with GPT exacerbation and HGV-DIt~ poslt lvl ty. After reactivation, the level of preS antigens returned to the basal values.
]n conclusion the detection of preSl and preS2 antigens in serum, is more frequent in those patientswhlt high viral replication. Furthermore. among anti-HOe carriers with a viral reactivation, synthesis of preS antigens takes place again.
281 THE EFFECT OF VASOPRESSIN ON INDOCYANINE GREEN ELIMINATION IN
PATIENTS WITH CIRRHOSIS
S. ISLAM, F. BALLET, Y. CHRETIEN, R. POUPON. S e r v i c e d ' h ~ p a t o l o g i e ,
HGpital Saint-Antoine 75571 Paris Cedex 12 - France -
Vasopressin (Vp) has both hemodynamic and metabolic effects on the liver. We have previously shown that intravenous administration of Vp to cirrhotics reduces the intrinsic hepatic clearance (Vmax/km) of Indocyanine green (ICG). This may be either due to reduction of Vmax by a direct metabolic effect of Vp on the exposed hepato- cytes or to the increase of apparent km by decreasing the fraction o£ hepatic blood flow wich perfuses the functional areas of the liver. In order to elucidate the mechanism for the reduction of clearance Vmax/km of ICG by Vp we studied in 10 cirrhotic patients its effect on first order hepatic clearance and Vmax, a flow independent parameter. Under Vp clearance of ICG was reduced from 4.07 ~ O.67 to 3-09- 0.53 ml/min/kg body weight (P< O.02), Vmax was not modified significantly
+ + .
(42.23- 2/70 vs 40.67- 2.71 pg/mxn/kg body weight), calculated Kmwas zncreased ÷ + /
from 9-59- 0.96 to 12.03- 1.17 pg/ml and the clearance Vmax/km was reduced from + + . .
4.95- O.72 to 3.82- O.59 ml/mzn/kg body wezght (P< 0.02). These data suggest that the reduction of the clearance Vmax/km of ICG by Vp is not due to a direct metabolic effect on the hepatocytes but probably results from a decrease of the functional hepatic blood flow.
S146
