Sildenafil does not influence hepatic venous pressure gradient in patients with cirrhosis

作     者：Jens Otto Clemmesen Annamaria Giraldi Peter Ott Kim Dalhoff Bent Adel Hansen Fin Stolze Larsen 

作者机构：Department of HepatologyRigshospitaletUniversity Hospital of Copenhagen Clinical PharmacologyRigshospitaletUniversity Hospital of Copenhagen 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2008年第14卷第40期

页      面：6208-6212页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Rigshospitalet,University of Copenhagen,The Laerdal Foundation for Acute Medicine Savvaerksejer Jeppe Juhl and wife Ovita Juhls Foundation The Novo Nordisk Foundation The AP-Mфller Foundation an unrestricted grant from Pfizer,Denmark 

主　　题：Cirrhosis Sildenafil Portal hypertension Portal hemodynamics Hepatic blood flow Erectile dysfunction Hepatic venous pressure gradient 

摘      要：AIM： To investigate if sildenafil increases splanchnic blood flow and changes the hepatic venous pressure gradient （HVPG） in patients with cirrhosis. Phosphodiesterase type-5 inhibitors are valuable in the treatment of erectile dysfunction and pulmonary hypertension in patients with end-stage liver disease. However, the effect of phosphodiesterase type-5 inhibitors on splanchnic blood flow and portal hypertension remains essentially unknown. METHODS： Ten patients with biopsy proven cirrhosis （five females/five males, mean age 54：1：8 years） and an HVPG above 12 mmHg were studied after informed consent. Measurement of splanchnic blood flow and the HVPG during liver vein catheterization were done before and 80 min after oral administration of 50 mg sildenafil. Blood flow was estimated by use of indocyanine green clearance technique and Fick＇s principle, with correction for non-steady state. RESULTS： The plasma concentration of sildenafil was 222 ± 136 ng/mL 80 min after administration. Mean arterial blood pressure decreased from 77 ±7 mmHg to 66 ± 12 mmHg, P = 0.003, while the splanchnicblood flow and oxygen consumption remained unchanged at 1.14 ± 0.71 L/min and 2.3 ± 0.6 mmol/ min, respectively. Also the HVPG remained unchanged （18 ± 2 mmHg vs 16 ± 2 mmHg） with individual changes ranging from -8 mmHg to ±2 mmHg. In seven patients, HVPG decreased and in three it increased. CONCLUSION： In spite of arterial blood pressure decreases 80 min after administration of the phosphodiesterase type-5 inhibitor sildenafil, the present study could not demonstrate any clinical relevant influence on splanichnic blood flow, oxygen consumption or the HVPG.