慢性阻塞性肺病患者血浆内皮素水平与肺血流动力学的关系

本文报告采用放射免疫方法测定慢性阻塞性病２４例（ＣＯＰＤ）患者体静脉，肺动脉，体动脉血的血浆ＥＴ－１水平，并与１６例正常对照组作了比较，ＣＯＰＤ患者尚进行了肺动脉压力直接测定，结果表明，ＣＯＰＤ患者ＥＴ－１水平显著高于正常组（Ｐ〈０．００１），肺动脉高压（ＰＡＨ）组ＥＴ－１水平显著高于ＰＡＨ组（Ｐ〈０．０５）。本文还分参与ＣＯＰＤ患者血浆ＥＴ－１水平的升高在ＰＡＨ形成可能是参与发病的因素之定。血浆     

硫化氢供体对大鼠高肺血流性肺动脉高压中内皮素-1及结缔组织生长因子表达的影响

目的：探讨硫氢化钠（NaHS）对大鼠高肺血流性肺动脉高压中内皮素-1(ET-1)及结缔组织生长因子(CTGF)表达的影响。方法:32只雄性SD大鼠随机分为分流组（n=8）、分流+NaHS组（n=8）、假手术组（n=8）和假手术+NaHS组（n=8）。对分流组和分流+NaHS组大鼠行腹主动脉-下腔静脉穿刺建立高肺血流动物模型。分流11周后，分别测定大鼠肺动脉收缩压（SPAP）、血浆ET-1含量、肺组织硫化氢（H2S）含量、肺组织ET-1mRNA的表达及肺动脉CTGF蛋白的表达。结果:分流11周，大鼠SPAP明显高于假手术组(P<0.05)；分流组大鼠肺组织ET-1mRNA表达、血浆ET-1含量以及肺腺泡肌型动脉CTGF表达明显高于假手术组；肺组织H2S含量明显低于假手术组(P<0.05)；应用NaHS干预11周，分流+NaHS组大鼠H2S含量明显高于、而SPAP明显低于假手术组(P<0.05)；分流+NaHS组大鼠血浆ET-1含量及肺组织ET-1mRNA的表达明显低于分流组(P<0.05)；分流+NaHS组大鼠肺动脉CTGF蛋白表达明显低于分流组(P<0.05)。结论: NaHS可能通过降低血管活性肽ET-1 及CTGF在肺组织的表达参与调节高肺血流性肺动脉高压的形成。     

疏血通对慢性阻塞性肺疾病合并肺动脉高压患者凝血状态及血清NO、NOS水平的影响

目的 观察疏血通治疗慢性阻塞性肺疾病(COPD)合并肺动脉高压(PAH)的疗效及对患者凝血状态及血清NO、NOS水平的影响.方法 将80例COPD合并PAH患者随机分为对照组和观察组,每组40例.对照组给予常规综合治疗,观察组在对照组基础上加用疏血通注射液治疗.分别于治疗前后检测患者血清一氧化氮(N0)、一氧化氮合成酶(NOS)、内皮素-1(ET-1)、抵抗素水平及血红蛋白(HB)、全血高切、低切黏度,比较两组治疗前后肺动脉收缩压、血气指标、肺功能指标及症状、体征改善情况.结果 治疗前,观察组与对照组各项测定指标差异均无统计学意义;治疗后,观察组较对照组血清NOS、NO水平明显升高(P＜0.05),ET、抵抗素水平明显降低(P＜0.05);全血高切黏度、全血低切黏度及HB水平明显降低(P＜0.05);肺动脉收缩压明显降低(P＜0.05),血气指标(PaO2、PaCO2、SaO2)、肺功能指标(FEV1、FEV1/FVC)及咳嗽、喘息、紫绀等症状、体征评分明显改善(P＜0.05).结论 疏血通辅助治疗COPD合并PAH,可通过调节血清NO、ET-1平衡,降低血清抵抗素水平,改善血管内皮功能,缓解血液高凝状态,降低肺动脉压,从而明显改善患者血气指标、肺功能指标及临床症状、体征.     

Value of M-mode echocardiography in assessing pulmonary arterial pressure in patients with chronic lung disease

Pulmonary valve echography was technically possible in 44 of 120 patients with chronic lung disease (CLD). Mean pulmonary arterial pressure (Ppa) was significantly correlated with right ventricular isovolumetric relaxation ratio (RVIRT/RVET) as derived from the movement of cusps in valves of the right heart (r = 0.842; p less than 0.001). Prolonged RVIRT was found in 52% of patients with Ppa greater than 20 mmHg and in all ten patients with Ppa greater than 35 mmHg. Other echographic signs, including abnormal right ventricular systolic time intervals (STI), 'a' wave amplitude, right to left ventricular ratio (RV/LV) and interventricular septum diastolic bulging (IVS-B), were less sensitive, but found more often; when higher Ppa was recorded at catheterization in a given patient (r = 0.869; p less than 0.001). Approximate echographic estimation of Ppa in patients with chronic lung disease is possible if right ventricular systolic and diastolic time intervals can be measured and if abnormalities in right ventricular dimensions, interventricular septum motion and pulmonary valve echogram are considered. In contrast to pulmonary fibrosis, technical problems in adequate visualization of right heart valves in chronic obstructive lung disease limit the use of M-mode echo assessment of Ppa to a clinically unacceptable 22% of subjects.     

缺氧大鼠出、入肺血、肺组织及心室肌降钙素基因相关肽和内皮素-1含量的变化

目的和方法:采用放免法观察常压间断缺氧大鼠出、入肺血和肺及心室肌组织匀浆中降钙素基因相关肽(CGRP)和内皮素-1(ET-1)的含量变化,并分析其与缺氧性肺动脉高压(HPH)和右心肥大间的相关关系。结果:正常大鼠入肺血CGRP含量显著高于出肺血,而ET-1含量和ET-1/CGRP比值则显著低于出肺血(P<0.01);随缺氧时间的延长,缺氧大鼠出肺血CGRP含量显著升高(P<0.05),与其肺动脉平均压(mPAP)呈正相关,而ET-1/CGRP比值则明显降低(P<0.05),与其mPAP呈负相关(r=-0.896,P<0.05);与对照组比较,缺氧大鼠入肺血及肺组织匀浆中CGRP和ET-1的含量及ET-1/CGRP比值均呈现先升高后降低趋势,至缺氧21d时入肺血的3项指标均接近正常水平;缺氧21d大鼠出肺血CGRP含量显著高于其入肺血(P<0.05)。结论:结果提示肺内CGRP和ET水平的失调在慢性HPH和右心肥大发生机制中起重要的作用。     

SOX5基因多态性与慢性阻塞性肺疾病及并发症肺动脉高压的关联性分析

目的:通过观察慢性阻塞性肺疾病(COPD)稳定期患者、COPD合并肺动脉高压(PH)患者及健康者之间SOX5基因单核苷酸多态性(SNPs)的分布差异,初步探索SOX5基因多态性与COPD相关PH易感性的关联。方法:连续选择2013年4月~2015年4月就诊于宁夏人民医院总院及宁南分院呼吸内科的COPD稳定期患者250例,根据COPD诊治指南(2013年版)诊断标准入组,并且就诊当天全部进行超声心动图检查,根据肺动脉收缩压(PASP)结果分为COPD合并PH组(PASP≥50 mm Hg)103例和COPD非PH组(PASP50 mm Hg)147例。健康对照组选择同期在宁夏人民医院体检的健康者127例。使用Sequenom Mass ARRAY SNP检测系统检测所有受试者SOX5基因rs10842262和rs11046966位点的基因型,统计基因型频率并对比各组间差异。结果:健康对照组与COPD组之间(包括COPD合并PH及未合并PH组的全部患者)以及COPD合并PH组与COPD非PH组之间在年龄、性别和吸烟指数上的差别均无统计学显著性。健康对照组与COPD组之间SOX5基因rs10842262位点及rs11046966位点基因型频率分布的差异均存在统计学显著性(P0.05)。COPD合并PH组与COPD非PH组之间SOX5基因rs10842262位点及rs11046966位点各基因型频率分布的差异无统计学显著性。结论:SOX5基因rs10842262和rs11046966位点的基因多态性与COPD的易感性相关,但与COPD相关PH的易感性还不能认为有关联。     

Measurement of right ventricular ejection fraction with krypton-81m in chronic obstructive pulmonary disease

Thirty patients with chronic obstructive pulmonary disease (COPD) and 15 healthy volunteers have been studied to assess the value of measuring right ventricular ejection fraction (RVEF) at rest with a perfusion of krypton-81m (81mKr). With this perfusion, equilibrium RVEF can be measured in a 30 degrees right anterior oblique projection, avoiding a superimposition of cardiac cavities. The average RVEF of the patients with COPD was significantly lower than that of the normal patients (36.3 +/- 9.3% vs 52.6 +/- 3.9%; p less than 0.001). An inverse linear relation was found between mean pulmonary artery pressure (Ppa) and RVEF (r = -0.543; p less than 0.01). The RVEF in a group of 15 patients with COPD and pulmonary hypertension (Ppa greater than 20 mmHg), averaged 30.4 +/- 7.26%, which was significantly lower than that of the other 15 COPD patients with normal Ppa, whose RVEF averaged 42.3 +/- 7.1% (p less than 0.01). Taking a RVEF value less than or equal to 35% as an indicator of pulmonary hypertension, the sensitivity was 80% and specificity was 75%, the predictive value for a positive test was 75%, and for a negative test was 80%. A positive but weak correlation was found between RVEF and PaO2 (r = 0.52; p less than 0.01), SaO2 (r = 0.41; p less than 0.05) and the forced expiratory volume in one second (FEV1) (r = 0.40; p less than 0.05). No correlation was found between RVEF and prior history of right cardiac insufficiency, PaCO2, pH, the ratio FEV1/vital capacity, ECG signs of cor pulmonale and left ventricular ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)     

贝前列素钠治疗肺源性心脏病肺动脉高压的临床研究

目的:观察贝前列素钠治疗肺源性心脏病(肺心病)肺动脉高压的临床疗效。方法:将68例肺心病急性发作期患者随机分为对照组(n=31)和贝前列素钠组(n=37)。两组患者均给予抗感染、止咳、化痰、平喘、强心利尿等常规治疗,贝前列素钠组在上述治疗的基础上加口服贝前列素钠治疗。比较两组疗效和外周动脉压(PABP)、肺动脉压(PAP)、左室射血分数(LVEF)、血脑钠肽(BNP)、血气[酸碱度(pH),氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2)]及血清C反应蛋白(CRP)、内皮素-1(ET-1)、一氧化氮(NO)水平变化。结果:贝前列素钠组总有效率明显高于对照组(94.59%vs 77.42%,P0.05),显效率也显著高于对照组(48.65%vs 16.12%,P0.01)。治疗后两组PAP、CRP、ET-1、NO、BNP、血气指标较治疗前均明显改善(P0.05或P0.01);贝前列素钠组较对照组PAP、PaCO2、ET-1、BNP降低更明显(P0.01),PaO2、SaO2、NO升高更显著(P0.01)。结论:贝前列素钠可以明显降低肺心病肺动脉高压患者肺动脉压,改善心功能,这可能与其降低ET-1和提高NO水平有关。     

外周血中性粒细胞/淋巴细胞比值在慢性阻塞性肺病相关肺动脉高压患者中的预后价值

目的：探讨外周血中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)对慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)相关肺动脉高压患者预后的评判价值。方法：选择2013年1月至2014年3月收治入上海交通大学医学院附属新华医院急诊科的200例COPD相关肺动脉高压(pulmonary hypertension,PH)患者为研究对象,对其进行至少2年的生存随访,随访终点为全因死亡,按照生存情况分为生存组和死亡组;记录各组入院24 h的一般临床资料,血常规[C反应蛋白(C-reactive protein,CRP)、中性粒细胞计数(neutrophils count,NEU)及淋巴细胞计数(lymphocyte count,LYM)并计算两者间比值(NLR)]、肌酐、尿素氮、胆红素、WHO肺动脉高压功能分级、肺动脉收缩压等;绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析NLR预测患者预后的临床价值;并以Kaplan-Meier法绘制观察指标不同水平下的生存曲线,进行生存分析。COX回归分析各指标提示预后的价值。结果：死亡组患者NLR,CRP,WHO肺动脉高压功能分级、肺动脉收缩压、尿素氮、肌酐、中性粒细胞计数高于生存组,淋巴细胞计数低于生存组,差异均具有统计学意义(P<0.05)。根据ROC曲线分析,NLR的ROC曲线下面积(AUC)为0.720(P<0.01),高于肌酐(AUC=0.716)、中性粒细胞计数(AUC=0.655)、肺动脉收缩压(AUC=0.652)及CRP(AUC=0.643)。当NLR截断值为4.7时,其灵敏度为74.2%,特异度为72.0%。Kaplan-Meier生存曲线分析显示,NLR值水平较高组预后明显差于水平较低组(P<0.01)。单因素Cox回归分析提示NLR是提示患者不良预后的危险因素,多因素Cox回归分析(P>0.05)。结论：NLR水平与COPD相关肺动脉高压患者临床预后呈明显相关;NLR水平越高则提示病情较重,预后较差。     

Frequency of Pulmonary Hypertension in Patients with COPD due to Biomass Smoke and Tobacco Smoke

Objectives; Pulmonary hypertension (PH) is a common and well established complication of chronic obstructive pulmonary disease (COPD). Its presence is associated with decreased survival. This study was designed to investigate the PH frequency and its relations in hospitalized tobacco and biomass related COPD patients. Methods and Results; The study was a retrospective review of inpatients with COPD defined as a history of tobacco or biomass smoking, Pulmonary function tests (PFT) within stable status, an echocardiogram within stable status. PH was defined as systolic pulmonary artery pressure (sPAP) >35 mmHg. Of the 694 individuals, 600 had suitable aspects for inclusion of study. All Females were biomass exposer and males were tobacco smoker. The Prevalence of PH was found more frequent in females than males. It was more prominent in moderate level COPD cases (56,2% and 37,5%, P<0,002). Both groups had airflow limitation, hypercapnia and hypoxemia, but no differences were found in terms of PaCO(2) and PaO2. However, FEV1 % was lower in males than females (p<0,005). On the other hand, FVC % was lower in the females compared with the males (p < 0.02). When analyzing the influence of PFT and demographic parameters on PH in separate COPD level groups, the results a bit varied among the groups. Conclusion; Our study demonstrated that PH frequency is higher in female COPD cases due to biomass smoke than in male COPD cases due to tobacco smoke. The influence of FVC % on the risk of a person having PH increased with increasing COPD level.     

肺心病患者血浆CGRP与ET-1的变化

本文通过对35例肺心病患者心导管检查分别于急性发作期和缓解期二次测定血流动力学指标,同时用放免法测定其血浆CGRP、ET-1水平。结果表明,肺心病急性发作期CGRP、ET-1及PAPM、PVR均显著高于缓解期和对照组(p<0,01)。缓解期与对照组比较无明显变化(p>0.05);吸30％氧60分钟,CGRP上升而ET-1下降,并与PAPM,paO_2存在明显相关性。由此推测ET-1水平的升高和CGRP水平的降低可能是肺动脉压力升高的重要原因。因此,积极改善缺氧,降低血浆ET-1水平,提高CGRP水平对防治肺心病肺动脉高压有重要意义。     

Correlation between congenital heart disease complicated with pulmonary artery hypertension and circulating endothelial cells as well as endothelin-1

Objective: To investigate changes in the level of circulating endothelial cells (CECs) and endothelin-1 (ET-1) in peripheral venous blood of the patients with congenital heart disease (CHD) complicated with pulmonary artery hypertension (PAH), and research on their effects in the onset and progress of CHD complicated with PAH. Methods: A case-control study including 30 cases of healthy controls, 15 cases of left-to-right shunt CHD without PAH, 26 cases of CHD complicated with mild PAH, and 17 cases of CHD complicated with moderate-severe PAH was performed. We used flow cytometry to measure the percentage of CECs accounting for nucleated cells in whole blood, and enzyme linked immunosorbent assay (ELISA) to measure the level of ET-1 in serum. The differences of above-mentioned biomarkers between different groups were compared. Results: (1) The level of CECs and ET-1in the group of moderate-severe PAH was significantly higher than those in the group of mild PAH and the group of CHD without PAH. Significantly difference was also observed between the level of CECs and ET-1 in the group of mild PAH and those in the group of CHD without PAH and the control group. Meanwhile, the level of CECs and ET-1 in the group of large shunt was significantly higher than those in the group few shunt and few-medium shunt. (2) Strong positive correlations were observed between pulmonary artery systolic pressure and percentage of CECs as well as ET-1 production. Mean pulmonary artery pressure also positively correlated with percentage of CECs as well as ET-1 production. (3) Arterial partial pressure of oxygen as well as arterial oxygen saturation negatively correlated with the level of CECs, whereas the volume of left-to-right shunt positively correlated with the level of ET-1. (4) The level of CECs and ET-1 were positively correlated as well in CHD patients. Conclusions: CHD complicated with PAH is associated with increased CEC counts and ET-1 production. This study suggests that CECs and ET-1 could be used as clinical biomarkers to define medical strategies for control of PAH.     

L-精氨酸对缺氧性肺动脉高压大鼠内皮素释放的影响

目的：探讨Ｌ－精氨酸（Ｌ－Ａｒｇ）对缺氧性肺动脉高压（ＨＰＨ）大鼠血浆内皮素－１（ＥＴ－１）释放的影响。方法：将Ｗｉｓｔａｒ大鼠４０只分为：对照组,缺氧组,缺氧＋Ｎ＾ω－硝基－Ｌ－精氨酸甲脂（Ｌ－ＮＡＭＥ）组和缺氧Ｌ－Ａｒｇ组。结果：缺氧组的肺动脉平均压（ｍＰＡＰ）显著高于对照组（Ｐ〈０．０５）,缺氧组＋Ｌ－Ａｒｇ组的ｍＰＡＰ显著低于缺氧组（Ｐ〈０．０５）及缺氧＋Ｌ－ＮＡＭＥ组（Ｐ〈０．０１）,缺     

西拉普利对低氧大鼠肺动脉和心肌细胞增殖的抑制作用

目的：探索cilazapril 对低氧大鼠肺血管和心肌细胞增殖的抑制机理。 方法： 采用生化、放射免疫、免疫组织化学、细胞凋亡标记和血流动力学技术研究低氧肺血管及心肌细胞增殖和结构重建。 结果： （1）低氧大鼠mPAP显著增高，伴有肺动脉血管管腔狭窄、管壁增厚，心肌肥大，R/L+S增高。（2）B组、C组大鼠肺动脉和右心肌细胞增殖指数（PI）均分别明显高于A组，而C组明显低于B组。ET-1免疫组化染色阳性细胞主要分布在肺动脉血管壁和心肌细胞上，染色程度由强到弱依次为B组>C组>A组。（3）B组大鼠ET-1水平和ACE活性明显高于A组，而C组显著低于B组。（4）直线相关分析显示ET-1、ACE分别与R/(L+S)、mPAP、肺动脉PI、心肌PI呈正相关；多元回归分析显示ET-1和ACE可能是影响PI的主要因素。 结论： 低氧大鼠存在细胞过度增殖状态，继发肺血管、右心结构重建是低氧性肺动脉高压发病机理之一。Cilazapril通过抑制ACE和ET-1的促增殖作用，阻止肺血管及心肌重建，对低氧性肺动脉高压的防治有一定作用。     

白藜芦醇苷对慢性常压低氧性肺动脉高压模型中磷脂酶A2、一氧化氮和内皮素水平的影响

目的： 观察白藜芦醇苷（PD）对慢性常压低氧性肺动脉高压大鼠血浆及肺匀浆中磷脂酶A2(PLA2)、一氧化氮（NO）和内皮素1（ET-1）水平的影响，并探讨可能的机制。 方法: 29只健康SD大鼠随机分为正常对照组、单纯低氧组和低氧加PD组。右心导管法检测大鼠肺动脉平均压力（mPAP），观察右室/左室+室间隔重量比值（R/L+S）、血浆及肺匀浆中PLA2活性、NO和ET-1含量的变化。 结果: 低氧21 d后大鼠mPAP、R/L+S、血浆及肺匀浆中PLA2活性和ET-1含量显著高于对照组，NO含量显著低于对照组。PD预处理组上述变化可受抑制或减轻。 结论: PD可有效防治慢性常压低氧性大鼠肺动脉压力的升高，其机理与抑制PLA2活性及ET-1释放，促进NO产生有关。     

Sleep apnea and pulmonary hypertension

Summary The pulmonary artery pressure values of 65 patients with sleep apnea syndrome were measured at rest and during ergometer exercise up to 100 W. Pulmonary hypertension at rest was found in 13, and during exercise in 31 more patients. Only 8 patients with pathological pressure findings suffered from pulmonary hypertension in combination with a pulmonary or cardiac disease. In the other 36 patients, no indication of a primary cause of pulmonary hypertension apart from sleep apnea syndrome could be found. Out of the 65 patients, 11 with a finding of more than 20 apnea episodes per hour's sleep underwent polysomnographic recordings in the sleep laboratory. The hemodynamic parameters were continuously measured. All 11 patients had a finding of severe sleep apnea with more than 300 apnea episodes during the night of recording. In 6 patients, the appearance of apnea episodes was accompanied by only moderate changes in pulmonary artery pressure. In 5 patients, there were critical increases in pulmonary artery pressure, which went along with increases in cardiac output and in pulmonary capillary wedge pressure. Increases in pulmonary vascular resistance were established in 3 out of these 5 patients, and a slight decrease in 2. The mechanism of hypoxic vasoconstriction of the pulmonary arteries may account for the pressure increases in 3 of our patients, but fails to explain the findings in the other 2 patients. Nocturnal changes in pulmonary artery pressure in patients with sleep apnea may therefore have different causes. Pulmonary hypertension constitutes a severe complication in patients with sleep apnea. As 55% of all sleep apnea patients were found to suffer from pulmonary hypertension without any indication of a primary pulmonary or cardiac disease, the possibility that pulmonary hypertension results should not be underestimated in patients with suspected sleep apnea syndrome. Measurements of the pulmonary artery pressure must therefore be included in the examination regimen of such patients.Abbreviations ECG electrocardiogram - REM rapid eye movement     

妊高征患者血浆一氧化氮和内皮素变化以及对胎儿的影响

目的：探讨一氧化氮（ＮＯ）和内皮素（ＥＴ－１）在妊高征发病中的作用及其对胎儿生长发育的影响。方法：采用比色法和放射免疫法对正常妊娠妇女２７例,正常未孕组２０例９对照组）,妊高征患者５２例（妊高征组）的血浆、新生儿脐血（２３例）中ＮＯ和ＥＴ－１水平进行检测。结果：妊高征组ＥＴ－１水平较对照组高,以中重度妊高征组增高显著（Ｐ〈０．０１）。ＮＯ水平较对照组低,差异有显著性（Ｐ〈０．０５）。在中重度妊高征者中,合并胎儿生长发育迟缓组（ＩＵＧＲ）母血和新生儿脐血ＥＴ－１水平明显高于 且。ＮＯ水平则明显低于未合并ＩＵＧＲ组。结论：ＮＯ的合成、释放减少与内皮细胞损伤ＥＴ－１释放增加,在妊高征发病中超重要作用。并且影响胎儿的生长发育。     

高肺血流量所致肺动脉高压大鼠肺血管结构和气体信使分子的变化

目的:探讨高肺血流量所致肺动脉高压大鼠肺血管结构和两种气体信使分子的变化。方法:对大鼠行腹主动脉-下腔静脉分流术。11周后,以右心导管法测定肺动脉平均压(PAMP)。检测右心室/体重(RV/BW)和右心室/左心室+室间隔(RV/LV+S)比值。观测肺血管显微及超微结构的变化。并且以分光光度计测定血浆一氧化氮(NO)和一氧化碳(CO)含量,以免疫组织化学方法检测肺动脉内皮细胞内皮型NO合酶(eNOS)和平滑肌细胞血红素加氧酶-1(HO-1)的表达。结果:分流组大鼠PAMP、RV/BW及RV/(LV+S)比值明显高于对照组(P均<001)。光镜下,肺小血管肌化程度明显增强,肺中、小型肌型动脉相对中膜面积及厚度明显增加。电镜下,肺腺泡内动脉内皮细胞增生、变性,内弹力层粗细不均,平滑肌细胞肥厚、向合成表型转化。并且分流组大鼠血浆NO含量明显高于对照组(P<001),肺动脉内皮细胞eNOS表达明显增强。而分流组大鼠血浆CO含量和肺动脉平滑肌细胞HO-1表达与对照组相比无明显变化。结论:肺血管结构重建是左向右分流所致肺动脉高压的重要病理基础,NO体系可能在其形成中起重要的调节作用。     

血浆microRNA-21水平与左室射血分数保留的心力衰竭相关性肺高压的关系

目的:探讨血浆微小RNA-21(miR-21)水平与左室射血分数保留的心力衰竭(HFpEF)相关性肺高压(PH-HFpEF)的关系。方法:选择2014年1月～2017年2月在江西省人民医院心内科就诊的HFpEF患者102例,通过三尖瓣反流压差法估测肺动脉收缩压(pulmonary artery systolic pressure,PASP),并按PASP分为PH-HFpEF组(n=36,PASP≥50 mmHg)和HFpEF组(n=40,PASP 50 mmHg),另选年龄和性别相应的同期健康体检者作为对照组(n=36),比较各组患者的临床资料,血浆miR-21水平与临床资料的相关性用Spearman相关分析,血浆miR-21水平预测PH-HFpEF准确性用受试者工作特征(ROC)曲线分析。多因素logistic回归分析与PH-HFpEF相关的危险因素。结果:PH-HFpEF组患者年龄、血浆内皮素1(ET-1)、血浆白细胞介素6(IL-6)、脑钠尿肽(BNP)和左房直径(LAD)均高于HFpEF组(P 0. 05)。PH-HFpEF组血浆miR-21表达明显高于HFpEF组及健康对照组(P 0. 05)。Spearman相关分析显示,血浆miR-21与PASP (r=0. 267,P=0. 000)、血浆IL-6 (r=0. 302,P=0. 013)和左心室重量指数(LVMI)(r=0. 515,P=0. 036)相关;血浆IL-6与ET-1正相关(r=0. 622,P=0. 002);PASP分别与血浆IL-6 (r=0. 36,P=0. 023)、ET-1 (r=0. 76,P=0. 004)、BNP (r=0. 43,P=0. 031)及LAD (r=0. 39,P=0. 044)正相关。血浆miR-21诊断PH-HFpEF的ROC曲线分析显示,曲线下面积为0. 8。多因素logistic回归分析显示,血浆miR-21相对表达水平、LAD、BNP与HFpEF患者肺高压相关。结论:血浆miR-21水平与PHHFpEF呈正相关,是HFpEF患者出现肺高压的独立预测因素。血浆miR-21可能是PH-HFpEF的标志物。     

Role of reactive oxygen species in vascular remodeling associated with pulmonary hypertension

Several manifestations of neonatal pulmonary hypertension are associated with vascular remodeling, resulting in increased muscularity of the small pulmonary arteries. Abnormal structural development of the pulmonary vasculature has been implicated in persistent pulmonary hypertension of the newborn (PPHN). Increased plasma levels of the vasoconstrictor endothelin-1 (ET-1) have been demonstrated in patients with PPHN, which is likely to contribute to hypertension. In addition, several studies have identified a role for ET-1 in the proliferation of vascular smooth muscle cells (SMCs), suggesting that ET-1 may also be involved in the vascular remodeling characteristic of this disease. However, the mechanisms of ET-1-induced SMC proliferation are unclear and appear to differ between cells from different origins within the vasculature. In SMCs isolated from fetal pulmonary arterial cells, ET-1 stimulated proliferation via an induction of reactive species (ROS). Furthermore, other lines of evidence have demonstrated the involvement of ROS in ET-1-stimulated SMC growth, suggesting that ROS may be a common factor in the mechanisms involved. This review discusses the potential roles for ROS in the abnormal pulmonary vascular development characteristic of PPHN, and the treatment strategies arising from our increasing knowledge of the molecular mechanisms involved.