Effect of somatostatin versus octreotide on portal haemodynamics in patients with cirrhosis and portal hypertension.
OBJECTIVE
Elevated portal inflow is part of the pathogenesis of portal hypertension in patients with cirrhosis. Vasoactive substances appear to play a primary role in the regulation of portal flow. The aim of this study was to investigate the effects of somatostatin and octreotide on portal pressure and plasma levels of insulin-like growth factor (IGF-1), nitric oxide (NO), endothelin-1 (ET-1) and glucagon (GLU).


METHODS
Portal pressures of 14 cirrhotic patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) were directly measured via a catheter placed in the portal vein. Portal pressure and IGF-1, NO, ET-1 and GLU plasma levels were determined at baseline, and at 8 h and 24 h after administration of somatostatin or octreotide via portal vein catheter in a randomized, double-blind, cross-over design.


RESULTS
The average decrease in portal pressure after intravenous infusion of somatostatin and octreotide was 9.4 +/- 1.0 cmH2O and 5.0 +/- 1.0 cmH2O, respectively (P < 0.01). Plasma levels of GLU and IGF-1 decreased significantly 8 and 24 h after somatostatin and octreotide infusion (P < 0.05). However, there were no significant decreases in plasma NO or ET-1 levels. There was a significant difference between somatostatin and octreotide groups (P < 0.01).


CONCLUSIONS
Both somatostatin and octreotide can significantly reduce portal pressure, although somatostatin is more potent than octreotide. The underlying mechanisms may involve inhibition of the secretion of GLU, IGF-1 and other hormones as well as a decrease in hepatic metabolism and portal inflow leading to a reduction in portal pressure.
Yang
Jian-Fen
JF
Research Institute of General Surgery, Jinling Hospital Nanjing 210002, Jiangsu Province, China.
Wu
Xing-Jiang
XJ
Li
Jie-Shou
JS
Cao
Jien-Min
JM
Han
Jian-Ming
JM
D000328:Adult; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005934:Glucagon / Q000097:blood; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D017082:Portal Pressure / Q000187:drug effects; D013004:Somatostatin / Q000627:therapeutic use*
D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D005934:Glucagon; D015282:Octreotide