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Relationship between angiotensin-(1-7) and angiotensin Ⅱ correlates with hemodynamic changes in human liver cirrhosis

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World Journal of Gastroenterology 2009年第20期15卷 2512-2519页

作者： walkíria wingester vilas-boas Antnio Ribeiro-Oliveira Jr Regina Maria Pereira Renata da Cunha Ribeiro Jerusa Almeida Ana Paula Nadu Ana Cristina Simoes e Silva Robson Augusto Souza dos Santos Laboratory of Hypertension Department of Physiology Biological Sciences institute Federal University of Minas Gerais Av. Antonio Carlos 6627 Belo Horizonte MG 31270-901 Brazil Laboratory of Endocrinology Department of Medicine Faculty of Medicine Federal University of Minas Gerais Av. Alfredo Balena 190 Belo Horizonte MG 30130-100 Brazil Hospitalar Foundation of the State of Minas Gerais FHEMIG Belo Horizonte MG Brazil Department of Pediatrics Faculty of Medicine Federal University of Minas Gerais Av.Alfredo Balena 190 Belo Horizonte MG 30130-100 Brazil

AIM： To measure circulating angiotensins at different stages of human cirrhosis and to further evaluate a possible relationship between renin angiotensin system （RAS） components and hemodynamic changes. METHODS： Patients were allocated into 4 groups： mild-to-moderate liver disease （MLD）, advanced liver disease （ALD）, patients undergoing liver transplantation, and healthy controls. Blood was collected to determine plasma renin activity （PRA）, angiotensin （Ang） Ⅰ, Ang Ⅱ, and Ang-（1-7） levels using radioimmunoassays. During liver transplantation, hemodynamic parameters were determined and blood was simultaneously obtained from the portal vein and radial artery in order to measure RAS components. RESULTS： PRA and angiotensins were elevated in ALD when compared to MLD and controls （P 〈 0.05）. In contrast, Ang Ⅱ was significantly reduced in MLD. Ang-（1-7）/Ang Ⅱ ratios were increased in MLD when compared to controls and ALD. During transplantation, Ang Ⅱ levels were lower and Ang-（1-7）/Ang Ⅱ ratios were higher in the splanchnic circulation than in the peripheral circulation （0.52 ± 0.08 vs 0.38 ±0.04, P 〈 0.02）, whereas the peripheral circulating Ang Ⅱ/Ang Ⅰ ratio was elevated in comparison to splanchnic levels （0.18 ±0.02 vs 0.13 ±0.02, P 〈 0.04）. Ang-（1-7）/ Ang Ⅱ ratios positively correlated with cardiac output （r = 0.66） and negatively correlated with systemic vascular resistance （r = -0.70）. CONCLUSION： Our findings suggest that the relationship between Ang-（1-7） and Ang Ⅱ may play a role in the hemodynamic changes of human cirrhosis.

关键词： Renin-angiotensin system Liver cirrhosis Angiotensin-(1-7) Angiotensin Ⅱ Splanchnic circulation Angiotensin converting enzyme 2

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Effect of propranolol on the splanchnic and peripheral renin angiotensin system in cirrhotic patients

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World Journal of Gastroenterology 2008年第44期14卷 6824-6830页

作者： walkíria wingester vilas-boas Antnio Ribeiro-Oliveira Jr Renata da Cunha Ribeiro Renata Lúcia Pereira Vieira Jerusa Almeida Ana Paula Nadu Ana Cristina Sim■es e Silva Robson Augusto Souza Santos Laboratório de Hipertenso Departamento de Fisiologia e BiofísicaICB-UFMGAv. Antonio Carlos6627Belo HorizonteMG31270-901Brazil Laboratório de Endocrinologia Departamento de Clínica MédicaFaculdade de Medicina-UFMGAv. Alfredo Balena190Belo HorizonteMG30130-100Brazil Departamento de Pediatria Faculdade de MedicinaUniversidade Federal de Minas Gerais (UFMG)Av. Alfredo Balena190Belo HorizonteMG30130-100Brazil

AIM:To evaluate the effect of β-blockade on angiotensins in the splanchnic and peripheral circulation of cirrhotic patients and also to compare hemodynamic parameters during liver transplantation according to propranolol pre-treatment or not. METHODS:Patients were allocated into two groups:outpatients with advanced liver disease(LD) and during liver transplantation(LT). Both groups were subdivided according to treatment with propranolol or not. Plasma was collected through peripheral venipuncture to determine plasma renin activity(PRA),Angiotensin(Ang) Ⅰ,Ang Ⅱ,and Ang-(1-7) levels by radioimmunoassay in LD group. During liver transplantation,hemodynamic parameters were determined and blood samples were obtained from the portal vein to measure renin angiotensin system(RAS) ***:PRA,Ang Ⅰ,Ang Ⅱ and Ang-(1-7) were signifi cantly lower in the portal vein and periphery in all subgroups treated with propranolol as compared to non-treated. The relationships between Ang-(1-7) and Ang Ⅰ levels and between Ang Ⅱ and Ang Ⅰ were significantly increased in LD group receiving propranolol. The ratio between Ang-(1-7) and Ang Ⅱ remained unchanged in splanchnic and peripheral circulation in patients under β-blockade,whereas the relationship between Ang Ⅱ and Ang Ⅰ was significantly increased in splanchnic circulation of LT patients treated with propranolol. During liver transplantation,cardiac output and index as well systemic vascular resistance and index were reduced in propranolol-treated subgroup. CONCLUSION:In LD group,propranolol treatment reduced RAS mediators,but did not change the ratio between Ang-(1-7) and Ang Ⅱ in splanchnic and peripheral circulation. Furthermore,the modification of hemodynamic parameters in propranolol treated patients was not associated with changes in the angiotensin ratio.

关键词： β-blockade Cirrhosis Renin angiotensinsystem Angiotensin-(1-7)

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Thromboelastographic Profile of Patients with Hyperparathyroidism Secondary to Chronic Kidney Failure Submitted to Total Parathyroidectomy

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Open Journal of Anesthesiology 2013年第8期3卷 363-366页

作者： walkíria wingester vilas boas Cristiano Barbosa de Oliveira Thadeu Alves Máximo Carlos Alexandre de Freitas Trindade Alexandre de Andrade Sousa Developed in Hospital das Clínicas da Universidade Federal de Minas Gerais HC-UFMG Belo Horizonte Brazil

Coagulopathy in surgical patients can cause perioperative complications, as both bleeding and thromboembolic events increase surgical morbimortality. The recognition of preexisting disorders and the understanding of the dynamic changes in hemostasis during surgery are prerequisites of safe patient management. The perioperative management of patients with chronic kidney failure is a huge challenge due to both the hypercoagulable state and increased risk of bleeding. Classic laboratory exams performed for the evaluation of blood clotting seem insufficient regarding the determination of the risk of bleeding and thrombosis in surgical patients. As patients with chronic kidney failure develop secondary hyperparathyroidism, the aim of the present study was to describe a case series and correlate the perioperative thromboelastographic profile of patients with chronic kidney failure submitted to parathyroidectomy with their secondary hyperparathyroidism.

关键词： Thromboelastography Chronic Renal Failure Hyperparathyroidism Total Thyroidectomy

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