[Pathogenic effects of level of nitric oxide, hyponatremia and heart function on hepatorenal syndrome]

To analyze the changes of liver function, renal function, electrolytes, heart function and serum nitric oxide (NO) in chronic severe hepatitis patients with hepatorenal syndrome (HRS) by plasma exchange (PE), study the relationship of NO, hyponatremia, heart function with HRS.

A total of 20 chronic severe hepatitis patients with HRS were recruited. All were treated thrice by PE. The parameters of blood pressure, heart rate, 24 h urinary volume, liver function indicators, renal function indicators, NO, cardiac troponin T (cTnT), brain natriuretic peptide (BNP), aldosterone, interleukin-6, tumor necrosis factor-α and plasma ammonia were measured before PE, during PE and after PE. Their differences were compared before, during and after PE.

The NO level of HRS before PE was (113 ± 26) µmol/L, the level of Day 1 after PE (78 ± 24) µmol/L and the level of Day 3 after PE was (85 ± 29) µmol/L. All NO levels were lower than that before PE (all P < 0.05). Creatine level of HRS before PE was (191 ± 43) µmol/L and the level of Day 1 after PE (142 ± 42) µmol/L. All levels were lower than that before PE (all P < 0.05). The level of Day 3 after PE was 221 ± 105 µmol/L and it was higher than that before PE (P < 0.05). At pre-, during- and post-PE, the level of sodium was low than normal (normal range: 135 - 145 mmol/L), the level of aldosterone higher than normal (normal range: 10 - 27 ng/L), the level of cTnT higher than normal (normal range: < 14 ng/L) and the level of BNP higher than normal (normal range: < 366 ng/L). The levels of model for end-stage liver disease (MELD) score, bilirubin, urea, cysteine proteinase inhibitor C and ammonia decreased during PE, but increased post-PE. Systolic pressure and 24 h urinary volume decreased gradually. In this study, 8 patients died and 12 were discharged from hospital.

Serum nitric oxide is not the sole occurring factor for hepatorenal syndrome. Hyponatremia and impaired heart function may be the key factors for hepatorenal syndrome.