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目的探讨高原慢性肺心病(HACCP)患者肺血管活性因子变化及其与肺动脉高压(PAH)的关系。方法采用放射免疫分析法检测65例HACCP急性加重期和60例缓解期患者血浆中介素(IMD)、肾上腺髓质素(ADM)、内皮素-1(ET-1)含量,用血气分析仪测定动脉血氧分压(PaO2),用多普勒超声心动仪测定肺动脉血流频谱,计算平均肺动脉压(mPAP),并与40例当地健康人比较。结果 HACCP急性加重期和缓解期患者血浆IMD、ADM、ET-1及mPAP[分别为(156.6±15.2)pg/mL、(71.7±6.3)pg/mL、(90.8±9.5)ng/L、(44.7±6.5)mmHg和(112.3±12.5)pg/mL、(47.8±4.2)pg/mL、(64.9±6.6)ng/L、(34.9±5.2)mmHg]较对照组[分别为(60.6±9.8)pg/mL、(21.8±3.2)pg/mL、(34.8±4.3)ng/L、(21.2±3.4)mmHg]显著升高,PaO2[分别为(36.4±5.3)mmHg、(48.8±4.4)mmHg]较对照组[(68.2±3.5)mmHg]显著降低(均P<0.01)。急性加重期与缓解期比较亦有非常显著性差异(均P<0.01)。急性加重期及缓解期患者mPAP与血浆IMD、ADM、ET-1均呈显著正相关(分别r=0.688、0.719、0.723及0.569、0.591、0.627,均P<0.01),PaO2与IMD、ADM、ET-1均呈显著负相关(分别r=-0.625、-0.698、-0.638及-0.641、-0.536、-0.562,均P<0.01)。结论 IMD、ADM、ET-1共同参与了HACCP患者PAH形成的病理生理过程,其比例失衡可能是导致高原肺心病低氧性PAH发生发展的重要因素。
Objective To investigate the changes of pulmonary vasoactive factors and its relationship with pulmonary hypertension (PAH) in patients with high altitude chronic pulmonary heart disease (HACCP). Methods The plasma levels of interleukin (IMD), adrenomedullin (ADM) and endothelin-1 (ET-1) were detected by radioimmunoassay in 65 HACCP patients with acute exacerbation and 60 patients with remission. PaO2 was measured. Pulmonary arterial blood flow spectrum was measured by Doppler echocardiography, mean pulmonary arterial pressure (mPAP) was calculated, and compared with 40 healthy local people. Results Plasma levels of IMD, ADM, ET-1 and mPAP were (156.6 ± 15.2) pg / mL, (71.7 ± 6.3) pg / mL and (90.8 ± 9.5) ng / L respectively in patients with acute exacerbation and remission 44.7 ± 6.5) mmHg and (112.3 ± 12.5) pg / mL, (47.8 ± 4.2) pg / mL and (64.9 ± 6.6) ng / L and (P <0.001), P <0.01, P <0.001), P <0.01) mmHg] compared with the control group [(68.2 ± 3.5) mmHg] (all P <0.01). Acute exacerbation and remission also have very significant differences (all P <0.01). There was a significant positive correlation between mPAP and IMD, ADM and ET-1 in patients with acute exacerbation and remission (r = 0.688, 0.719,0.723 and 0.569,0.591,0.627, respectively, P <0.01) ET-1 were significantly negative correlation (r = -0.625, -0.698, -0.638 and -0.641, -0.536, -0.562, all P <0.01). Conclusion IMD, ADM and ET-1 participate in the pathophysiological process of PAH formation in HACCP patients. The unbalanced ratio may be an important factor for the occurrence and development of hypoxic PAH in plateau patients with pulmonary heart disease.