Spider angiomas in patients with liver cirrhosis: Role of vascular endothelial growth factor and basic fibroblast growth factor

Abstract

AIM:To investigate whether vascular endothelial growth factor (VEGF) and basic fibroblastic growth factor (bFGF) are associated with spider angiomas in patients with liver cirrhosis. METHODS:Eighty-six patients with liver cirrhosis were enrolled and the number and size of the spider angiomas were recorded. Fifty-three healthy subjects were selected as controls. Plasma levels of VEGF and bFGF were measured in both the cirrhotics and the controls. RESULTS:Plasma VEGF and bFGF were increased in cirrhotics compared with controls (122±13 vs. 71±11 pg/mL, P=0.003 for VEGF; 5.1±0.5 vs. 3.4±0.5 pg/mL, P=0.022 for bFGF). In cirrhotics, plasma VEGF and bFGF were also higher in patients with spider angiomas compared with patients without spider angiomas (185±28 vs. 90±10 pg/mL, P=0.003 for VEGF; 6.8±1.0 vs. 4.1±0.5 pg/mL, P=0.017 for bFGF). Multivariate logistic regression showed that young age and increased plasma levels of VEGF and bFGF were the most significant predictors for the presence of spider angiomas in cirrhotic patients (odds ratio [OR]=6.64, 95 % confidence interval [CI]=2. P=0.002; OR=4.35, P=0.014; OR=5.66, P=0.004, respectively). CONCLUSION:Plasma VEGF and bFGF are elevated in patients with liver cirrhosis. Age as well as plasma levels of VEGF and bFGF are significant predictors for spider angiomas in cirrhotic patients.

Are the Spider Angiomas Skin Markers of Hepatopulmonary Syndrome?

“…The pathogenesis of intrapulmonary vascular dilatation is still debated, several mechanisms have been proposed, including: imbalance between vasoconstrictors and vasodilators substances; the increase of pulmonary endothelium sensitivity to a vasodilator not produced or not metabolized by the diseased liver, or even hyporesponsiveness to vasoconstrictor substances (12,14,16,23,31) .…”

“…They may be present in physiological situations, as in pregnancy, on children, on women in use of oral contraceptives, but are commonly asso-ciated with chronic liver diseases, its prevalence is variable, ranging from 4 to 47% depending on diagnostic criteria and methods used (23) .…”

“…Still little is known about the pathogenesis of intrapulmonary vascular dilation, it is believed that it is due to a number of factors such as the imbalance between vasoconstrictors and vasodilators substances, and/or increased sensitivity of pulmonary endothelium to a vasodilator and/or hyporesponsiveness to vasoconstrictors substances (12,14,16,23,29) .…”

“…The SA are lesions that appear as red spots, shiny, with numerous microvascular radiations wich pales when pressure on a central spot is temporarily applied (2,5,15,23,32,36) . They may be present in physiological situations, as in pregnancy, on children, on women in use of oral contraceptives, but are commonly asso-ciated with chronic liver diseases, its prevalence is variable, ranging from 4 to 47% depending on diagnostic criteria and methods used (23) .…”

“…lar-arterial gradient of oxygen (AAG)  15 mmHg] is multifactorial, being caused either by intrapulmonary vascular dilations, and by changes in alveolar-capillary diffusion of oxygen and/or the imbalance in the ventilation/alveolar perfusion (12,14,16,23,29) .…”