1. State Medical University named after I. I. Mechnikov of Russian Federation Ministry of Public Health (St. Petersburg, Russian Federation)

Keywords:chronic hepatitis,endothelial disfunction,portohepatic hemodynamics,hepatic stellate cells,polyhepatography,L-ornithine-L-aspartate

Abstract:We investigated 97 patients with chronic viral hepatitis В и C, 30- nonalcoholic and alcoholic steatohepatitis with liver fibrosis 0-1stage. For the estimation of liver microcirculation we used non-invasive method polyhepatography (modificated liver impedansometry). Activation of HSCs was determined by expression of SMA-alfa in liver bioptate. Endothelial function was estimated by peripheral arterial tonometry (EndoPAT-2000), by expression of eNOS, iNOS in liver bioptate (immunohystochemical reactions) and by determination of NO metabolits in blood. For correction of hepatic blood flow disorders we used L-ornithine-L-aspartate, test with nitrates and deep respiration. we revealed the disorders of intrahepatic microcirculation on presinusoidal level (in-flow) at the viral patients and on sinusoidal level (out-flow) at steatohepatitis with increase of basic resistance and decrease of blood filling of the liver. The endothelial disfunction was identified: disorders od endothelia-depended vasodilatation, increased NO metabolits in blood, presence of iNOS expression and moderate decreased eNOS in liver. In liver bioptate we revealed the signs of activation of HSCs - expression of SMA-alfa. L-ornithine-L-aspartate improved liver microcirculation in all patients. at the chronic liver diseases patients with fibrosis 0-1 we detected the hepatic microcirculation disorders in different levels in depending on the ethiology of the disease. Functional tests with nitrates confirmed functional character of this disorders in cases of fibrosis 0. Endothelial dysfunction and activation of HSCs are important pathogenetic factors of increased hepatic resistance. L-ornithine-L-aspartate can improve liver microcirculation.

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Full text is published :
SOME MECHANISMS OF INTRAHEPATIC HEMODYNAMIC DISORDERS AND ITS CORRECTION IN CHRONIC LIVER DISEASES WITH AN INITIAL STAGE OF FIBROSIS. Experimental and Clinical Gastroenterology Journal. 2018;150(02):183-191
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