Portal hypertension PH , a detrimental complication of many diseases, is abnormalities in pre-, intra-or post-hepatic portal venous system. Intrahepatic PH is the most common type, which is mainly cause by liver cirrhosis [ ], liver cancer, and sometimes intrahepatic vascular abnormalities [ ].Hepatic venous pressure gradient HVPG is the difference between wedged hepatic venous pressure and infra vena cava pressure. PH is defined as an HVPG higher than mmHg [ ]. According to absence or presence of complications splenomegaly and hypersplenism, esophageal varices and ascites , PH can be classified into compensated or decompensated phase. Meanwhile, an HVPG higher than mmHg has been considered as a direct predictor of decompensation and a -year-follow-up study showed the significant worse longterm survival when HVPG > mmHg [ -].In cirrhotic PH, increased intrahepatic vascular resistance IHVR is the primary factor [ , ] and subsequently increased portal vein inflow PVI worsens the situation of PH patients. This review will focus on the physiopathological changes happened in PH.. Contrastingly, extrahepatic NO is increased in PH patients. A clinical trial has shown that serum nitrate level was positively correlated with clinical presentation, e.g. pulse rate, jaundice, hepatic encephalopathy, lower limb edema and esophageal varices [ ]. It is well established that NO results in dilation of splanchnic and systemic circulation as a powerful vasodilator and blood level of NO is increased as PH progresses [ -]. Administration of CCl to eNOS -/-mice also led to an elevated NO production, which is eNOS independent [ ]. Another study suggested that iNOS might be involved [ ].
. . Carbon monoxideCarbon monoxide CO , a vasodilator producing by heme oxygenases HOs from heme [ ], changes as HO-expression altered in PH patients [ , ], which shares the same characters with NO [ ]. Expression of intrahepatic HO-and -decreased in cirrhotic rats than that in normal ones. In situ perfusion with CO-releasing molecule-, which leads to relaxation of hepatic stellate cells, and HO-inducer hemin could attenuated increased IHVR. ZnPP caused a higher IHVR attributing to inhibition of intrahepatic HOin cirrhotic liver[ ].But things are different in splanchnic and systemic circulation. Reportedly, portal vein pressure PVP was significantly higher in bile-duct-ligated rats than that in sham group. Meanwhile, mRNA and protein level of HO-was also elevated significantly in lung [ ].A clinical study has shown an activated HO/CO system in cirrhotic patients while the HOactivity and plasma level of CO were related with the severity of PH [ ]. Arterial blood gas analysis showed an increase of COHb in bile-duct-ligated rats which could be reversed by ZnPP [ ]. HO-could promote expression of VEGF and thereafter lead to formation of collateral vessels and higher splanchnic circulation [ ].
. . EndothelinEndothelin-ET-is the most powerful vasoconstrictor in ETs family [ ], which is primarily synthesized and acts in liver mainly in a paracrine fashion ...