Patterns of regional sympathetic nerve traffic in preascitic and ascitic cirrhosis

Authors

  • Massimo Pozzi,

    Corresponding author
    1. Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, and Monza, Milano, Italy
    • Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, Ospedale San Gerardo dei Tintori, Via Donizetti 106-20052 Monza, Milano, Italy. fax: (39) 039 322274
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  • Guido Grassi,

    1. Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, and Monza, Milano, Italy
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  • Elena Redaelli,

    1. Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, and Monza, Milano, Italy
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  • Raffaella Dell'Oro,

    1. Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, and Monza, Milano, Italy
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  • Laura Ratti,

    1. Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, and Monza, Milano, Italy
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  • Alessandro Redaelli,

    1. Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, and Monza, Milano, Italy
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  • Gerardo Foglia,

    1. Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, and Monza, Milano, Italy
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  • Alessandro Di Lelio,

    1. Dipartimento di Radiologia, Ospedale San Gerardo dei Tintori, Monza, Milano, Italy
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  • Giuseppe Mancia

    Corresponding author
    1. Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, and Monza, Milano, Italy
    2. Istituto Auxologico Italiano, Milano, Italy.
    • Cattedra di Medicina Interna, Università degli Studi di Milano-Bicocca, Divisione di Medicina 1, Ospedale San Gerardo dei Tintori, Via Donizetti 106-20052 Monza, Milano, Italy. fax: (39) 039 322274
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Abstract

Overactivity of the sympathetic nervous system and portal hypertension are key factors in the development of ascites in cirrhosis. The sympathoexcitation that characterizes the more advanced stages of liver diseases is less clearly defined in preascitic cirrhosis. We measured sympathetic nerve traffic to skeletal muscle (peroneal nerve) and to skin districts by microneurography in (1) 12 Child class A cirrhotic patients with clinically significant portal hypertension (portal pressure gradient > 10 mm Hg, 14.8 ± 1.2 mm Hg, mean ± SEM) but without actual or previous ascites, (2) 16 Child class C cirrhotic patients with tense ascites, and (3) 10 patients with mild congestive heart failure, a condition paradigmatic of a marked sympathetic activation. Muscle sympathetic nerve traffic was markedly increased in Child class C subjects as compared with controls (23.9 ± 1.6 bursts/min, P < .01) and superimposable to that recorded in heart failure patients (52.9 ± 4.7 vs. 60.3 ± 2 bursts/min, P = not significant). Muscle sympathetic nerve traffic was also increased in Child class A subjects (41.6 ± 2 bursts/min, P < .01 vs. controls) although to a lesser extent (P < .05 vs. Child class C patients). Skin sympathetic nerve traffic was within the normal range in all patients. Neurohormones were all markedly increased in Child class C subjects. Only norepinephrine was increased in Child class A patients. Our data show that sympathetic nerve traffic activation (1) is already detectable in Child class A cirrhosis when clinically significant portal hypertension is present but ascites never developed and (2) is not generalized because although muscle traffic is increased, skin traffic is within normal range. The role of drugs modulating sympathoactivation should be investigated in preascitic cirrhosis.

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