Changes in plasma ET-1 and NO in patients with severe acute pancreatitis and effect of alprostadil on ET-1 and NO

AIM: To detect the changes in plasma endothelin-1 (ET-1) and nitric oxide (NO) in patients with severe acute pancreatitis and to observe the effect of alprostadil on ET-1 and NO levels.

METHODS: Sixty patients with SAP were randomly divided into two groups: a control group (n = 30) or a combination group (n = 30). The control group received intravenous infusion of somatostatin on the basis of conventional therapy, and the combination group received intravenous infusion of alprostadil and somatostatin on the basis of conventional therapy. Plasma levels of ET-1 and NO were measured at admission, 12 h, 48 h, 72 h, and 1 week after onset, and ET-1/NO ratio was calculated.

RESULTS: Plasma levels of ET-1 and NO initially increased, peaked at 12 h, were still maintained at high levels at 72 h, and then declined at 1 week below the levels at admission. The trend of changes of ET-1 and NO were similar between the two groups from admission to 24 h (ET-1 at admission: 97.7 ng/L ± 14.9 ng/L vs 98.8 ng/L ± 15.6 ng/L; 12 h: 157.4 ng/L ± 14.4 ng/L vs 160.3 ng/L ± 15.8 ng/L; 24 h: 146.0 ng/L ± 18.8 ng/L vs 146.4 ng/L ± 19.2 ng/L; NO at admission: 29.0 µmol/L ± 4.4 µmol/L vs 29.7 µmol/L ± 6.0 µmol/L; 12 h: 40.2 µmol/L ± 3.9 µmol/L vs 41.2 µmol/L ± 5.5 µmol/L; 24 h: 39.7 µmol/L ± 4.7 µmol/L vs 39.7 µmol/L ± 4.6 µmol/L; P > 0.05 for all). The levels of ET-1 decreased more significantly from 48 h to 1 week in the combination group (48 h: 134.1 ng/L ± 18.5 ng/L vs 128.3 ng/L ± 17.8 ng/L; 72 h: 99.5 ng/L ± 16.6 ng/L vs 109.8 ng/L ± 17.3 ng/L; 1 wk: 71.4 ng/L ± 12.1 ng/L vs 78.8 ng/L ± 13.3 ng/L; P < 0.05 for all), while the levels of NO decreased more significantly in the control group (48 h: 30.1 µmol/L ± 4.9 µmol/L vs 33.8 µmol/L ± 4.1 µmol/L; 72 h: 22.2 µmol/L ± 4.8 µmol/L vs 28.0 µmol/L ± 4.2 µmol/L; 1 wk: 17.0 µmol/L ± 3.7 µmol/L vs 20.2 µmol/L ± 3.4 µmol/L; P < 0.05 for all).

CONCLUSION: ET-1 and NO are important factors mediating microcirculation disturbance in SAP. Alprostadil can ameliorate pancreatic microcirculation possibly by altering ET-1 and NO expression.