经导管置入Amplatzer封堵器治疗房间隔缺损前后血浆内皮素、一氧化氮、心钠素水平变化及意义

目的:探讨经导管置入Amplatzer封堵器治疗房间隔缺损前、后血浆内皮素1(ET-1)、一氧化氮(NO)、心钠素(ANP)水平变化。方法:22例房间隔缺损患者,按有、无肺动脉高压分为肺动脉高压组14例,无肺动脉高压组8例。分别测定术前、术后3天及3个月血浆ET-1、NO、ANP含量。结果:术前肺动脉高压组血浆ET-1、NO、ANP水平明显高于无肺动脉高压组(P<0.01)。无肺动脉高压组的ANP水平高于对照组。术后3天肺动脉高压组血浆ET-1、NO、ANP水平即出现下降(P<0.05),术后3个月已接近正常水平。结论:ET-1/NO动态平衡的改变,可能参与了肺动脉高压的发生、发展过程;ANP在肺动脉高压的发病机制中起着有益的生理调节作用;经导管置入AmpJatzer封堵器治疗房间隔缺损明显降低血浆ET-1、NO及ANP含量。     

脑梗死患者血浆纤溶指标的动态观察

目的　探讨脑梗死患者血浆中纤溶分子标志物———组织纤维蛋白溶酶原激活剂 (TPA)和纤溶酶原激活物抑制剂 (PAI 1)含量的动态变化及其临床意义。方法　采用酶免疫定量法对 30例首次急性脑梗死患者急性期和恢复期的血浆TPA和PAI 1含量进行测定 ,并选择 30名正常人作为对照。同时对比首次急性脑梗死 30例和再发脑梗死 2 8例急性期血浆TPA及PAI 1含量。结果　首次急性脑梗死患者恢复期的TPA低于急性期 ,高于正常对照组 ;PAI 1含量脑梗死恢复期明显高于急性期。再次发病急性脑梗死患者比首次发病急性脑梗死患者的PAI 1高。结论　PAI 1与脑梗死的发生与发展有着重要关系 ,应作为临床的重要危险因素对待。     

急性脑梗死患者血浆ET、ANP水平的相关性研究

采用均相竞争法直接测定急性脑梗死患者的血浆内皮素 (ET)、心钠素 (ANP)含量 ,并动态观察其变化。结果显示 ,脑梗死患者急性期血浆 ET、ANP含量明显高于对照组 (P<0 .0 1) ,随着时间的延长 ,二者含量均逐渐降低 ,但于发病半个月后仍高于正常。经对患者发病后第 2、6、10、15天的 ET、ANP结果作相关分析 ,发现四个时段的ET、ANP含量均呈正相关关系。认为脑梗死急性期血浆 ET与 ANP之间存在相互促进、相互抑制的关系。     

缺血性脑血管病患者血浆肾上腺髓质素与内皮素的测定及其临床意义

目的　监测缺血性脑血管病患者血浆肾上腺髓质素 (ADM)含量变化及其与血浆内皮素 (ET- 1)的关系 ,探讨其在缺血性脑血管病发生发展中的作用及其临床意义。方法　应用放射免疫法测定 88例缺血性脑血管病患者 (包括 4 0例脑梗死和 4 8例腔隙性脑梗死 )和 4 5例正常对照者的血浆 ADM和 ET- 1含量。结果　缺血性脑血管病组患者血浆 ADM含量及 ET- 1含量均高于正常对照组含量 (P<0 .0 5 ) ;脑梗死组血浆 ADM水平高于腔隙性脑梗死组的水平 (P<0 .0 5 ) ;缺血性脑血管病组血浆 ADM水平与血浆 ET- 1呈显著正相关 (r=0 .5 85 ,P<0 .0 5 )。结论　肾上腺髓质素参与了缺血性脑血管病的发生发展过程 ,可能对缺血性脑组织有保护作用。血浆ADM可作为脑梗死患者血管内皮损伤程度的指标之一     

脑梗死病人血浆D-二聚体水平的变化及其在预后判断中的意义

目的探讨脑梗死病人急性期和恢复期血浆D-二聚体水平的变化及其在诊断和预后判断中的意义.方法采用散射比浊法检测65例脑梗死病人急性期和恢复期以及30例健康体检者的血浆D-二聚体水平,脑梗死组急性期的血浆D-二聚体水平与对照组进行比较,并根据恢复期血浆D-二聚体水平比急性期下降或上升把病人分为两组,分别对其预后进行观察和比较.结果脑梗死组急性期血浆D-二聚体水平与正常对照组相比有统计学意义(P＜0.01);恢复期血浆D-二聚体水平比急性期下降病人预后良好,D-二聚体水平上升者预后不良(P＜0.01).结论脑梗死病人急性期和恢复期血浆D-二聚体水平的变化对诊断和预后判断有一定的指导意义.     

血浆心钠肽和内皮素1在心力衰竭患者中的浓度变化及相关性分析

目的探讨不同心功能分级心力衰竭患者心钠肽(ANP)、内皮素1(ET-1)、左室射血分数(LVEF)、左室舒张末期内经(LVEDD)是否有差异。方法应用ELISA法测定56例充血性心力衰竭(CHF)患者血浆ET-1和ANP浓度,心脏多普勒超声检查心脏LVEF和LVEDD。结果心衰组血浆ANP及ET-1浓度明显高于正常对照组,且均随心衰程度的加重而显著增加,心衰患者中血浆ANP与ET-1浓度变化成正相关,ANP、ET-1均与LVEF呈明显负相关,且与LVEDD呈正相关。结论血浆ANP、ET-1水平在心衰患者中明显升高,心功能越差,ANP及ET-1水平越高;心衰患者中,ANP及ET-1的合成与释放水平可能与LVEF和LVEDD有关。     

老年急性脑梗死患者血浆B型脑钠肽的变化及其意义

目的 观察老年脑梗死患者血浆中脑钠肽(BNP) 水平的变化, 探讨BNP在脑梗死发病中的意义.方法 检测83例老年脑梗死患者血浆中的BNP水平,与50名健康体检者进行比较.脑梗死按病程分为急性期(发病3 d内)和亚急性期(发病3～10 d);根据头颅MRI分型为大面积脑梗死(病灶直径> 5 cm)(26例)和非大面积脑梗死(病灶直径≤5 cm) (57例).结果 脑梗死组急性期血浆BNP含量显著高于正常对照组(P<0.01) ,也显著高于亚急性期(P<0.01),大面积脑梗死组血浆BNP含量显著高于非大面积脑梗死组(P<0.01).结论 急性期和大面积脑梗死患者血浆BNP 水平明显升高,提示BNP可能在脑梗死的发病过程中起着关键作用,有望成为脑梗死病情程度重要的评价指标之一.     

缺血性心脑血管疾病患者血浆纤溶酶原激活物及纤溶酶原激活物抑制剂1的测定及临床意义

目的研究缺血性心脑血管疾病患者血浆尿激酶型纤溶酶原激活物及其受体、组织型纤溶酶原激活物及其抑制剂1的水平及意义。方法应用酶联免疫吸附试验测定急性脑梗死、急性心肌梗死及不稳定型心绞痛患者血浆尿激酶型纤溶酶原激活物及其受体、组织型纤溶酶原激活物及其抑制剂1的水平。结果(1)脑梗死患者急性期血浆尿激酶型纤溶酶原激活物轻度升高(P>0.05),恢复期明显回落(P<0.05),尿激酶型纤溶酶原激活物受体水平在急性期明显升高(P<0.01),恢复期进一步升高;血浆中组织型纤溶酶原激活物含量在急性期明显低于对照组(P<0.01),而纤溶酶原激活物抑制剂1含量则明显高于对照组(P<0.01),恢复期纤溶酶原激活物抑制剂1水平趋于正常,而血浆中组织型纤溶酶原激活物水平与对照组比较仍存在一定差异(P<0.05)。(2)急性心肌梗塞患者血浆尿激酶型纤溶酶原激活物受体水平急性期明显升高(P<0.05),恢复期进一步升高(P<0.01),尿激酶型纤溶酶原激活物水平均大致正常;急性期血浆中血浆中组织型纤溶酶原激活物及纤溶酶原激活物抑制剂1含量均明显高于对照组(P<0.01),恢复期明显回落,纤溶酶原激活物抑制剂1趋于正常,血浆中组织型纤溶酶原激活物水平仍高于对照组(P<0.05)。(3)不稳定型心绞痛患者急性期(入院时)血浆尿激酶型纤溶酶原激活物受体水平明显升高(P<0.01),恢复期(入院后二周)回落,但仍明显高于对照组(P<0.05),尿激酶型纤溶酶原激活物水平与对照组比较均未见明显差异(P>0.05);急性期血浆中组织型纤溶酶原激活物含量明显低于正常组(P<0.01),而纤溶酶原激活物抑制剂1含量略高于对照组(P>0.05),恢复期两者含量均趋于正常(P>0.05)。结论缺血性心脑血管疾病患者存在不同程度的凝血纤溶系统失平衡,对疾病的发生发展起重要作用。     

脑梗死患者血浆BNP与CRP浓度的变化及临床意义

目的探讨血浆脑钠肽(BNP)与C-反应蛋白(CRP)在脑梗死中的表达及其临床意义。方法应用酶联免疫分析法测定45例脑梗死急性期患者和40例亚急期患者血浆BNP与CRP浓度,并以30例健康自愿体检者作对照。结果脑梗死组急性期血浆BNP、CRP含量显著高于亚急期(P<0.01)与正常对照组(P<0.01),大面积脑梗死组血浆BNP、CRP含量显著高于非大面积脑梗死组(P<0.01),在非大面积梗死组中后循环梗死组血浆BNP含量显著高于前循环梗死组(P<0.01)。结论脑梗死患者血浆BNP和CRP水平明显升高,提示二者在脑梗死的发病过程中起重要作用。     

芪龙通络胶囊对急性脑梗死病人血管内皮功能的影响

目的观察芪龙通络胶囊对急性脑梗死病人血管内皮功能的影响。方法将100例急性脑梗死病人随机分为治疗组、观察组,每组50例。两组病人均根据病情给予抗血小板聚集、降血脂、降血压、扩张冠状动脉等常规治疗,观察组在常规治疗基础上口服芪龙通络胶囊。比较两组治疗前后血管内皮生长因子(VEGF)、一氧化氮(NO)、内皮素-1(ET-1)表达水平和美国国立卫生研究院卒中量表(NIHSS)评分,并观察药物不良反应。结果治疗前两组病人VEGF、NO、ET-1、NIHSS评分差异无统计学意义(P0.05)。治疗8周后,与对照组比较,观察组病人VEGF、NO表达水平明显升高(P0.05),ET-1水平和NIHSS评分则明显降低(P0.05)。观察组总有效率明显高于对照组(P0.05)。两组均未出现明显不良反应。结论芪龙通络胶囊能明显改善急性期脑梗死病人的血管内皮功能,治疗后临床症状明显减轻,且安全性好。     

Oxygen-mediated pulmonary vasodilation and plasma levels of endothelin-1, atrial natriuretic peptide and cyclic GMP in patients with left-to-right shunt and pulmonary hypertension

This study was performed to evaluate the role of endogenous endothelin-1 (ET-1), atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) in patients with left-to-right shunt and pulmonary hypertension. Further objectives were to study a possible feedback mechanism between ANP and ET-1 and to examine the influence of ANP on cGMP plasma levels. Finally, the role of these hormones in oxygen-mediated pulmonary vasodilation was examined. Plasma concentrations of ET-1, ANP and cGMP were studied in 39 patients with congenital heart disease and left-to-right shunt. Blood samples were taken from the pulmonary artery and pulmonary vein at cardiac catheterization at baseline and after breathing oxygen for 20 min. Patients were grouped according to the presence or absence of pulmonary hypertension (defined as mean Pp/Ps > or = 0.5). Patients with pulmonary hypertension (n = 18) were found to have significantly higher plasma ANP (665 [59-1358] versus 267 [47-832] pg/ml) and cGMP (21.5 [3.6-82.2] versus 7.8 [0-14.6] nM/L) levels than patients without pulmonary hypertension (n = 21). Pulmonary venous ET-1 plasma concentrations were above normal limits in one patient only. ANP plasma levels were not related to ET-1 and cGMP concentrations. There was no transpulmonary gradient for any of the factors. Pulmonary vasodilation in response to oxygen was found in 7 of 18 patients with PH, but was not associated with significant changes in ET-1, ANP or cGMP plasma concentrations. Patients with congenital heart disease and PH show an increase both in vasoconstrictive and vasodilating factors. The mechanism of oxygen-mediated vasodilation in these patients remains to be elucidated.     

Evaluation of plasma endothelin-1 levels in patients with cerebral infarction

Endothelin-1 (ET-1) is a vasoconstrictor peptide derived from endothelium. Many authors have shown that ischemic stroke is associated with elevated plasma ET-1 levels. Also, the present findings related to plasma ET-1 levels with clinical status, size of the infarction, location of the infarction, and prognosis of the cerebral infarction were contradictory. In this study, plasma ET-1 levels in 30 patients with cerebral infarction within 72 hours after the onset of focal neurologic deficit and at their seventh day postinfarction were measured by a microplate enzyme immunoassay. Thirty sex- and age-matched healthy subjects were accepted as a control group. The mean plasma ET-1 concentrations in patients on admission, in patients at day 7, and in control subjects were 1.93 +/- 1.79, 1.03 +/- 1.02, and 0.65 +/- 0.32 fmol/mL, respectively. The mean plasma ET-1 level of patients on admission was found to be significantly higher than in patients at day 7 and in control subjects (p < 0.05). No significant difference in ET-1 levels was observed between the patients at day 7 and control subjects. Furthermore, there was no correlation between plasma ET-1 concentration and size of infarction, location of infarction, degree of clinical neurologic deficit, or prognosis of cerebral infarction. It was concluded that plasma ET-1 levels shortly after ischemic stroke were increased, which may be associated with the acute-phase reaction of cerebral infarction and may have deleterious effects on development of neuronal injury.     

Plasma endothelin-1 level in chronic obstructive pulmonary disease: relationship with natriuretic peptide.

BACKGROUND AND OBJECTIVE: Endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by the vascular endothelium. The purpose of this study was to elucidate the pathophysiological role of ET-1 in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD). METHOD: We measured plasma ET-1 levels during right heart catheterization both at rest and during exercise on room air and while breathing oxygen in patients with COPD. In addition, we simultaneously measured plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). RESULTS: Plasma ET-1 levels at rest were significantly higher in 21 patients with COPD than in 16 control subjects (p < 0.001). For COPD patients, there was no correlation between the plasma ET-1 level and pulmonary arterial pressure or pulmonary vascular resistance at rest. On the other hand, there was a significant negative correlation between plasma ET-1 level and mixed venous oxygen tension (r = -0. 503, p < 0.05). Also, the plasma ET-1 level was positively correlated with those of ANP (r = 0.540, p < 0.05) and BNP (r = 0. 533, p < 0.05) at baseline. Oxygen administration significantly decreased plasma ET-1 levels at rest (p < 0.05). Plasma ET-1 levels did not change significantly with exercise despite the progression of pulmonary hypertension and hypoxemia. In contrast, plasma ANP and BNP levels both increased markedly with exercise (p < 0.01). CONCLUSION: We conclude that in patients with COPD, the plasma ET-1 level is not affected by acute progression of pulmonary hypertension and hypoxemia during exercise, and persistent hypoxemia may be associated with an increase in the plasma ET-1 level. In addition, our findings suggest that ANP and BNP may modulate the pulmonary vascular tone by interacting with ET-1 in these patients.     

急性脑梗死患者血浆及脑脊液t-PA及PAI-1含量测定及其临床意义

采用双抗体夹心固相酶联免疫吸附法（ELISA）检测35例急性服梗死患者血浆和其中31例患者脑脊液t－PA及PAI-1抗原含量，与35例对照组血浆和其中20例对照组脑脊液进行比较。结果：急性脑梗死组血浆t－PA含量高于对照组，PAI-I含量显著高于对照组；其脑脊液t－PA、PAI－1含量均显著高于对照组；脑脊液中t－PA、PAI－1的含量分别与血浆中t－PA、PAI－1含量呈正相关，认为急性脑梗死患者纤溶活性明显下降；t－PAE及PAI－1参与了脑梗死之病理过程；t－PA及PAI－1抗原含量是反映体内纤溶活性的两个重要指标，可用血浆或脊液t－PA、PAI－1的含量作为判断病情的参考指标之一。     

Response of vasoactive substance to blood pressure changes during hemodialysis in uremic patients

Ultrafiltration during haemodialysis (HD) may be the cause of blood pressure (BP) decline due to reduction of blood volume. In some patients, however, BP does not decrease or even rises during HD. The aim of the study was to answer the question: do uraemic hypertensive patients, showing a decline of mean blood pressure (MAP) during HD session (group A) differ from those showing a stable MAP during HD session (group B) with respect to hormonal profile of aldosterone (ALD), vasopressin (AVP), atrial natriuretic peptide (ANP), endothelin-1,2 (ET-1,2), blood nitric oxide (NO) and plasma renin activity (PRA). A total of 39 haemodialysed, hypertensive patients (17 female, 22 men) were studied. 24 patients (group A) showed a MAP decline of 10 mm Hg or more, while 15 patients (group B) showed MAP changes of less than +/- 10 mm Hg during HD session. PRA, ALD, AVP, ANP, ET-1,2, NO concentration were assessed in blood samples withdrawn from the arterial blood line before HD and after 60, 120, 180 and 240 minutes of HD session. Plasma ET-1,2 and blood NO concentration were also assessed after 30 minutes of HD. BV was continuously monitored with a Crit-Line equipment, BP was measured before and every 30 minutes on HD. Before HD session both examined groups showed similar baseline plasma levels of ALD, AVP, ANP, ET-1,2, NO, PRA and MAP. A 4-hours HD induced a significant increase in plasma ALD and AVP concentrations and a significant decline in ANP level in both groups of patients. In group A, PRA and blood NO concentration increased significantly, while plasma ET-1,2, level did not change during HD. In group B, no significant changes in PRA and blood NO level were noticed, while plasma ET-1,2 rose markedly. In addition in group B, a significant positive correlation was found between MAP and plasma ET-1,2 level changes, but a significant negative correlation between MAP and blood NO level changes. CONCLUSION: Patients with a decline of MAP over 10 mm Hg during HD differ from those with a stable MAP by a different response of plasma ET and blood NO to HD induced volume changes.     

老年脑出血患者血浆ET和ANP的变化及临床意义

目的测定老年脑出血患者血浆内皮素（ＥＴ）、心钠素（ＡＮＰ）浓度并探讨其临床意义。方法以放射免疫法测定老年和非老年健康人；老年及非老年脑出血患者不同时期血浆ＥＴ及ＡＮＰ水平。结果老年脑出血患者急性期血浆ＥＴ为１４８．１８ｎｇ／Ｌ，ＡＮＰ为５７．３３ｎｇ／Ｌ，较健康对照组明显升高（分别为Ｐ＜０．０１及Ｐ＜０．０５）。恢复期与对照组比较无明显差异。同期测定的非老年脑出血患者血浆ＥＴ和ＡＮＰ浓度与老年患者差异无显著意义（Ｐ＞０．０５），直线相关分析表明，老年脑出血患者急性期血浆ＥＴ与ＡＮＰ之间呈明显正相关。结论脑出血患者血浆ＥＴ、ＡＮＰ浓度的升高与脑出血的发生、病情的发展及转归有密切关系     

Atrial and brain natriuretic peptide and endothelin-1 concentration in patients with idiopathic arterial hypertension: the dependence on the selected morphological parameters

INTRODUCTION: The aim of the work was to study the maintenance of atrial and brain natriuretic peptide (ANP, BNP) and endothelin-1 (ET-1) in patients with idiopathic arterial hypertension and the relationships between cardiac morphological parameters and concentrations of examined peptides in group of patients with left ventricular hypertrophy (LVH). METHODS: Seventy-six patients were enrolled in the study: 21 patients with confirmed idiopathic arterial hypertension (group 1), 18 with idiopathic hypertension and eccentric hypertrophy (group 1a), 14 with idiopathic hypertension and concentric hypertrophy (group 1b), and 23 patients without arterial hypertension, organic heart disease, or chronic respiratory tract diseases (group 2 - control group). All subjects were submitted for echocardiographic evaluation. Posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left atrium diameter (LAD), left ventricular mass index (LVMI), ejection fraction (EF), fractional shortening (FS), midwall shortening fraction (MWS), and relative wall thickness index (RWT) were studied. Concentrations of ANP(1-28), BNP, and ET-1 were determined with the use of radioimmunological kits (RIA). The obtained results were subjected to statistical analysis. RESULTS: A considerable increase of ANP and BNP was observed in all patients with hypertension (group 1) in comparison to patients without hypertension (group 2). Significant increases of ANP were found in groups 1a and 1b in comparison to group 1 and 2, as well as considerably increase of BNP in group 1b compared to groups 1, 1a, and 2. In the group of patients with hypertension (group 1), a significant increase in the concentration of ET-1 compared to group 2 was found. However, the concentrations of ET-1 in groups 1 and 2 were not statistically different. Significant differences in concentrations of ET-1 between groups 1a, 1b, and 1 and 2 were seen. Significant correlations were found between concentrations of ANP, BNP, ET-1 and morphological parameters: PWT, IVST, LVMI and RWT. In group 1b, a correlation between concentrations of ANP, BNP, MWS, and LAD was found. The multiple regression analysis showed that RWT independently correlates with concentrations of ANP and BNP, and the concentration of BNP is in closer relation to RWT than ANP. In the case of ET-1, the multiple regression analysis did not show that LVMI or RWT had any independent influence on secretion of ET-1 in patients with idiopathic hypertension and LVH. CONCLUSIONS: Increased concentration of ANP in patients with idiopathic hypertension may point to the coexistence of complications with type of LVH. High concentration of BNP may specifically suggest concentric LVH. This is important - especially if there are difficulties in interpretations of results of other clinical examinations. However, increased concentrations of ET-1 in the plasma of patients with hypertension and LVH should not be treated as an indicator of LVH degree.