Nitroglycerine effects on portal vein mechanics and oxidative stress in portal hypertension

Table 1 Demographic and clinical characteristics of investigated groups n (%)

Clinical parameters	Patients(n = 39)	Control(n = 30)	P value
Average age (yr) (mean ± SE)	54.8 ± 1.3	42.5 ± 0.9	< 0.01
Gender
Male	34 (87.1)	17 (56.7)	< 0.01
Female	5 (12.9)	13 (43.3)	< 0.01
Body mass (kg ± SE)	72.5 ± 2.0	72.8 ± 2.6	NS
Height (cm ± SEM)	170.4 ± 1.4	171.1 ± 2.1	NS
Body mass index (mean ± SE)	41.9 ± 1.2	42.3 ± 1.3	NS
Diagnosis			< 0.01
Cirrhosis hepatis	38 (97.4)	0 (0)
Hepatitis B	1 (2.6)	0 (0)
Diameter liver (mm ± SE)	168.4 ± 3.1	147.3 ± 2.2	< 0.01
Ascites			< 0.01
Yes	4 (10.3)	0 (0)
No	35 (89.7)	30 (100)
Varices esophagi			< 0.01
Yes (Grade III)	3 (7.7)	0 (0)
No	36 (92.3)	30 (100)
AST (U/I ± SEM)	90.5 ± 15.5	21.4 ± 1.4	< 0.01
ALT (U/I ± SEM)	45.3 ± 8.6	24.1 ± 1.5	< 0.01
GGT (U/I ± SEM)	267.5 ± 41.6	35.6 ± 1.6	< 0.01
AST			< 0.01
Increased	25 (64.1)	0 (0)
Normal	14 (35.9)	30 (100)
ALT			< 0.01
Increased	12 (30.7)	0 (0)
Normal	27 (69.3)	30 (100)
GGT			< 0.01
Increased	22 (56.4)	0 (0)
Normal	17 (43.6)	30 (100)
Total bilirubin (μmol/L ± SE)	43.3 ± 8.0	18.6 ± 0.8	< 0.01
Direct bilirubin (μmol/L ± SE)	18.2 ± 3.9	2.9 ± 0.2	< 0.01
Total bilirubin			< 0.01
Increased	25 (64.1)	0 (0)
Normal	14 (35.9)	30 (100)
Direct bilirubin			< 0.01
Increased	29 (74.4)	0 (0)
Normal	10 (25.6)	30 (100)

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma glutamyltransferase; NS: Not significant.

Table 2 Haemodynamic and biomechanical parameters of portal vein before and after nitroglycerine administration

Parameters	Groups	0 min	P value	10 min	P value	15 min	P value
D (mm)	Patients	11.60 ± 0.32	< 0.01	13.81 ± 0.31b	< 0.01	13.63 ± 0.33b	< 0.01
	Controls	9.19 ± 0.33		11.02 ± 0.34b		11.72 ± 0.37b
CSA (cm2)	Patients	1.08 ± 0.06	< 0.01	1.52 ± 0.69b	< 0.01	1.49 ± 0.70b	< 0.01
	Controls	0.68 ± 0.05		1.09 ± 0.06b		1.11 ± 0.06b
Q (l/min)	Patients	0.61 ± 0.05	NS	0.80 ± 0.07b	NS	0.78 ± 0.71b	< 0.05
	Controls	0.66 ± 0.06		0.86 ± 0.05b		0.95 ± 0.08b
Sr (1/s)	Patients	66.50 ± 3.91	< 0.01	49.85 ± 3.07b	< 0.01	51.71 ± 3.30b	< 0.01
	Controls	139.87 ± 5.25		111.29 ± 5.57b		83.83 ± 5.58b
Vmean (cm/s)	Patients	9.39 ± 0.50	< 0.01	8.55 ± 0.55a	< 0.01	8.69 ± 0.57	< 0.01
	Controls	15.63 ± 0.48		13.13 ± 0.44b		14.34 ± 0.54b
Vmax (cm/s)	Patients	10.60 ± 0.57	< 0.01	9.77 ± 0.65b	< 0.01	9.84 ± 0.62b	< 0.01
	Controls	19.31 ± 0.56		16.51 ± 0.51b		18.03 ± 0.69b
Vmin (cm/s)	Patients	8.18 ± 0.43	< 0.01	7.34 ± 0.48b	< 0.01	7.53 ± 0.53b	< 0.01
	Controls	11.96 ± 0.48		9.75 ± 0.46b		10.65 ± 0.47b
RI	Patients	0.22 ± 0.01	< 0.01	0.24 ± 0.01	< 0.01	0.24 ± 0.01	< 0.01
	Controls	0.37 ± 0.02		0.41 ± 0.02		0.40 ± 0.01
L (cm)	Patients	13.69 ± 1.12	NS	17.95 ± 1.68b	NS	17.52 ± 1.58b	NS
	Controls	15.08 ± 1.56		17.00 ± 1.56a		21.26 ± 1.78b
Fideal	Patients	/	/	2.32 ± 0.21d	NS	2.11 ± 0.17d	< 0.05
	Controls	/		2.54 ± 0.34d		3.38 ± 0.51d
ΔPratio	Patients	/	/	0.66 ± 0.03	NS	0.68 ± 0.03	< 0.05
	Controls	/		0.68 ± 0.04		0.49 ± 0.04
F	Patients	/	/	1.34 ± 0.07	NS	1.31 ± 0.06	NS
	Controls	/		1.45 ± 0.10		1.48 ± 0.08
ΔP (mmHg)	Patients	/	/	0.004 ± 0.003	< 0.01	0.005 ± 0.003	< 0.05
	Controls	/		0.029 ± 0.006		0.014 ± 0.003e

Values are expressed as mean ± SE; P in colon 3, 5 and 7 relates to the existance of the difference between groups, while a and b represent the existance of difference between the initial measurement and the measurement in 10th or 15th min. d represents the existance of difference between F_ideal and F. e represents the existance of difference between the measurements in 10th and 15th min.

^aP < 0.05 vs 0 min,

^bP< 0.01 vs 0 min,

^dP < 0.01 vs F,

^eP < 0.05 vs 10 min. D: Portal diameter; CSA: Cross sectional area; Q: ; Sr: Shear rate; RI: Portal resistance index; L: Length; F_ideal: Expected (ideal) portal vein flow ratio; F: Portal vein flow ratio; ΔP_ratio: Pressure ratio; ΔP: Pressure difference; NS: Not significant.

Table 3 Parameters measured by three independent observers (I, II and III)

Parameters	Groups	0 min				10 min				15 min
		I	II	III	IA	I	II	III	IA	I	II	III	IA
D (mm)	Patients	11.47 ± 0.31	11.70 ± 0.33	11.59 ± 0.31	0.84	13.79 ± 0.31	13.86 ± 0.32	13.80 ± 0.31	0.89	13.61 ± 0.33	13.65 ± 0.35	13.64 ± 0.32	0.95
	Controls	9.22 ± 0.32	9.19 ± 0.34	9.22 ± 0.32	0.96	11.07 ± 0.35	10.91 ± 0.29	11.00 ± 0.35	0.84	11.80 ± 0.43	11.77 ± 0.39	11.55 ± 0.34	0.9
Vmax	Patients	10.55 ± 0.53	10.99 ± 0.64	10.17 ± 0.50	0.83	9.80 ± 0.63	10.84 ± 0.72	8.94 ± 0.52	0.73	9.91 ± 0.64	10.01 ± 0.62	9.52 ± 0.59	0.79
(cm/s)	Controls	19.74 ± 0.56	19.11 ± 0.52	19.07 ± 0.61	0.80	17.11 ± 0.53	16.44 ± 0.48	16.02 ± 0.50	0.79	18.11 ± 0.72	18.77 ± 0.81	17.43 ± 0.55	0.75
Vmin	Patients	8.11 ± 0.40	8.59 ± 0.51	7.73 ± 0.36	0.76	7.48 ± 0.51	7.22 ± 0.50	7.32 ± 0.44	0.83	7.68 ± 0.50	7.90 ± 0.59	7.01 ± 0.51	0.79
(cm/s)	Controls	12.12 ± 0.55	12.26 ± 0.60	11.46 ± 0.34	0.79	9.86 ± 0.48	9.89 ± 0.48	9.55 ± 0.42	0.84	10.89 ± 0.55	10.22 ± 0.43	10.78 ± 0.40	0.81

Interobserver agreement for quantitative parameters (portal vein diameter, maximal and minimal blood flow velocity) calculated from the comparison of data from all three observers. D: Portal diameter; IA: Interobserver agreement.