面罩双水平气道内正压通气对急性心力衰竭老年患者内皮素系统的影响及临床意义

目的 观察面罩双水平气道内正压通气（BiPAP）对急性心力衰竭老年患者内皮素系统的影响.方法 120例急性心力衰竭（AHF）老年患者随机分为常规治疗组（硝酸异山梨酯＋托拉塞米;A组,60例）和常规治疗基础上的BiPAP辅助治疗组（硝酸异山梨酯＋托拉塞米＋BiPAP;B组,60例）,20例正常人作为对照组.采用酶联免疫法测定两组治疗前后血浆ET-1水平,同时用半定量RT-PCR方法测定外周血单个核细胞表面ETA受体及ETB受体的表达.结果 （1）A组和B组ET-1水平在治疗前无显著差异（P＞0.05）,但均高于对照组（P＜0.01）;与治疗前相比,A组ET-1水平在治疗后4h开始出现显著下降（P＜0.05）,于12h达最低值;而B组ET-1水平在治疗后2h开始出现显著下降（P＜0.05）,于12 h达最低值;且两组间ET-1最低水平相比差异有显著性（P＜0.05）;（2）A组和B组治疗前ETA-mRNA、ETB-mRNA表达水平均高于对照组（P＜0.01）,但A组和B组间差异无显著性（P＞0.05）;与治疗前相比,A组ETA-mRNA表达水平在治疗后8h开始显著下降（P＜0.05）,在12h达最低值;而B组ETA-mRNA表达水平在治疗后6h开始出现显著下降（P＜0.05）,于10 h达最低值;且两组间ETA-mRNA最低水平相比差异有显著性（P＜0.05）;（3）与治疗前相比,A组在治疗后10h开始出现ETB-mRNA表达水平的显著下降（P＜0.05）,于14 h达最低值;而B组在治疗后8h开始出现ETB-mRNA表达水平的显著下降（P＜0.05）,于12 h达最低值;且两组间ETB-mRNA最低水平相比差异有显著性（P＜0.05）.结论 BIPAP治疗对AHF时老年患者ET系统的过度激活有一定的抑制作用.

The effect and clinical significance of bilevel positive airway pressure on plasma endothelin system in elderly patients with acute heart failure

Objective To investigate the effects of bilevel positive airway pressure on ET system in elderly patients with acute heart failure. Methods 120 elderly patients with AHF were randomly divided into routine treatment group （ 60 patients, Isoket＋ Torsemide Injection ; A group ）; BiPAP combined routine treatment group （60 patients, Isoket ＋ Torsemide Injection ＋ BiPAP; B group）, Healthy control group （20 cases）. Before and after treatment, plasma ET-1 level were detected by euzyme-linked immunosorbent assay, as well as expression of ETA and ETB receptor mRNA in peri- pheral blood monocyte were detected by semi-quantitative RT-PCR. Results （1） The differences of ET-1, ETA-mRNA, ETB-mRNA level in both group before the treatment were not statistically significant, they were all higher than those in control group （P〈0.01）; After the treatment, ET-1 level in A group start to decrease at 4 hours （P〈0.05）, and the lowest level were observed at 12 hours; however, ET-1 level in B group start to decrease at 2 hours （P〈0.05）, and the lowest level were observed at 12 hours; （2） After the treatment, expression of ETA-mRNA level in A group start to decrease at 8 hours （P〈0.05）, and the lowest level were observed at 12 hours; however, ETA-mRNA level in B group start to decrease at 6 hours （P〈0.05）, and the lowest level were observed at 10 hours; （3） After the treatment, expression of ETB-mRNA level in A group start to decrease at 10 hours （P〈0.05）, and the lowest level were observed at 14 hours; however, ETB-mRNA level in B group start to decrease at 8 hours （P〈0.05）, and the lowest level were observed at 12 hours. （4） after the treatment, the difference of lowest level of ET-1 、 ETA-mRNA, ETB-mRNA in both A group and B group were statistically significant （P〈0.05）. Conclusion Treatment of BIPAP may play inhibitive role to ET system in elderly patients with AHF.