慢性肺心病患者MDA、SOD和外周血淋巴细胞线粒体结构的观察

采用放射免疫法及硫代巴比妥酸荧光法分别检测了２０ 例慢性肺心病患者,１６ 例健康人的过氧化物歧化酶（ＳＯＤ） 、丙二醛（ＭＤＡ） ,并同时采用改良Ｂｏｙｕｎｎ 法分离固定淋巴细胞,对其淋巴细胞线粒体膜结构进行了研究。结果：肺心病病人的严重程度与ＳＯＤ含量、ＭＤＡ 水平、淋巴细胞线粒体数目及膜结构改变有相关性,心衰越重,ＭＤＡ 越高,淋巴细胞线粒体内的数目越多,线粒体嵴膜呈现不同程度的改变。提示：氧化与抗氧化失衡与肺心病患者淋巴细胞线粒膜结构的改变有一定的关系,可能是其影响细胞功能的靶部位,故对肺心病患者加强抗氧化的治疗,保持氧化与抗氧化的平衡状态,可能对于肺心病的治疗及预防具有重要意义     

慢性阻塞性肺疾病和肺心病患者血液动力学与循环内皮？…

目的 探讨慢性阻塞性肺疾病（ＣＯＰＤ０和肺心病时血循环内皮细胞、血液动力学的变化及意义。方法 运用右心导管检查技术和血循环内皮细胞（ＣＥＣ）分离技术，用硫巴比妥法及羟胺法测定血丙二醛（ＭＤＡ）及超氧化物歧化酶（ＳＯＤ）。结果 肺心病组肺动脉平均压［（ｍＰＡＰ）３．７６±０．７５ｋＰａ、血ＣＥＣ数量每０．９微升为１６．７０±２．６５与ＣＯＰＤ组８．４８±２．２３）比较，差异有显性（Ｐ〈０．０１），     

Studies of free radical metabolism in patients with cor pulmonale]

The levels of free radicals in the whole blood of the patients with cor pulmonale were determined using the method of electron spin resonance (ESR). The concentrations of serum SOD were determined using RIA. The concentrations of the MDA, vitamin E, selenium and the activities of the SeGSHPx, CAT of the patients were also measured using biochemical methods. The results showed that the level of free radical in the whole blood and serum MDA, SOD increase if compared with that of control group. The activities of SeGSH-Px, CAT and the concentration of vitamin E in serum of the patients are in lower level. These indicate that there is impairment in free radical metabolism of the patients.     

老年肺心病急性加重期血小板参数的变化与高凝状态的研究

目的探讨老年肺心病急性加重期血小板4项分析参数的变化及对机体凝血功能的影响。方法分别测定40例老年肺心病急性加重期病人、37例经治疗后的缓解期病人及35名健康老年人的血小板4项参数值,包括血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)、血小板分布宽度(PDW)。结果老年肺心病急性加重期病人PLT及PCT显著低于经治疗后的缓解期病人及健康老年人(P<0.01);而MPV,PDW则显著增高(P<0.05)。结论老年肺心病急性加重期可通过多种机制引起血小板参数的变化,进而造成机体高凝状态,是血栓及弥散性血管内凝血(DIC)形成的基础,同时对临床判断肺心病的病情及预后有重要意义。     

前列腺素E1对肺心病心衰疗效的观察

探讨前列腺素Ｅ１静脉滴注对肺心病心衰的疗效。方法对３０例肺心病心衰患者，应用前列腺素Ｅ１（ＰＧＥ１）２００μｇ／ｄ静脉滴注，疗程５天。于治疗前后同步检测内源性洋地黄因子（ＥＤＦ）、过氧化脂质（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）及动脉血氧分压（ＰａＯ２）、动脉血二氧化碳分压（ＰａＣＯ２）和观察症状体征变化，并与对照组（不用ＰＧＥ１）的３０例肺心病心衰患者及２０例健康者进行比较。结果两组肺心病心衰患者的ＥＤＦ、ＬＰＯ显著高于健康组（Ｐ＜０．００１），ＳＯＤ含量则显著降低（Ｐ＜０．００１）。治疗组病例治疗后ＥＤＦ、ＬＰＯ较治疗前显著降低（Ｐ＜０．００１），ＳＯＤ含量则显著升高（Ｐ＜０．００１），症状体征及血气参数显著改善（Ｐ＜０．０１～０．００１）。对照组（不用ＰＧＥ１）病例的ＥＤＦ、ＬＰＯ、ＳＯＤ、血气参数及症状体征，于治疗前、后无显著变化（Ｐ＞０．０５）。结论ＰＧＥ１对肺心病心衰患者确有较好的疗效。     

肺心病慢性呼吸衰竭患者脑诱发电位的研究

目的用诱发电位方法检测肺心病慢性呼吸衰竭患者在发生临床肺性脑病前脑功能的改变。方法对２８例老年肺心病慢性呼吸衰竭无肺性脑病临床表现的患者、２０例老年肺炎患者及３０例老年健康人同时进行脑干听觉、体感诱发电位（ＢＡＥＰ、ＳＥＰ）检查。结果ＢＡＥＰ异常：肺心病组２３例（８２％），肺炎组７例（３５％）；ＳＥＰ异常：肺心病组２４例（８６％），肺炎组８例（４０％）。经统计学检验，肺心病组ＢＡＥＰ、ＳＥＰ与健康组、肺炎组差异有显著性，肺炎组与健康组差异无显著性。结论肺心病慢性呼吸衰竭患者有脑干功能受损和弥漫性脑功能障碍。     

慢性肺原性心脏病左心功能的临床研究

目的：探讨慢性肺原性心脏病（以下简称肺心病）左心功能的变化。方法：采用二维及脉冲多普勒超声心动图测定慢性肺心病患者的左心功能，并与健康人及阻塞性肺气肿患者进行对照。结果：肺心病右心衰竭组患者的射血分数、每搏输出量、心输出量、心脏指数及快速充盈期与心房收缩期二尖瓣口血流比值均有下降，与正常对照组、慢性支气管炎肺气肿组及肺心病右心功能代偿组比较，上述各项指标均有显著差异，Ｐ分别＜０．０１、＜０．０１和＜０．０５。结论：肺心病右心衰竭患者可合并左心功能受损。     

Serum soluble Fas in patients with Schistosomal cor pulmonale

BACKGROUND: Schistosomal cor pulmonale is considered an important pathological condition in endemic areas. Few recent studies have reported the role of apoptosis in pulmonary hypertension. OBJECTIVES: The aim of this study was to assess serum levels of soluble Fas (sFas), an inhibitor of apoptosis, in patients with schistosomal cor pulmonale as compared to patients with cor pulmonale due to chronic obstructive pulmonary disease (COPD) and normal subjects. METHODS: Serum sFas was assessed in 15 men with schistosomal cor pulmonale (age 32 +/- 10 years), 15 men with chronic cor pulmonale secondary to COPD and 20 healthy men, matched for age. RESULTS: Serum levels of sFas were significantly higher in patients with schistosomal cor pulmonale (74 +/- 80 U/ml) than in patients with cor pulmonale due to COPD (15 +/- 10 U/ml) and normal subjects (19 +/- 11 U/ml, p < 0.001 in both). In patients with schistosomal cor pulmonale, sFas was significantly higher in patients with mean pulmonary artery pressure > 30 mm Hg as compared to patients with pressure < or = 30 mm Hg (109 +/- 97 vs. 34 +/- 20 U/ml, p = 0.01). There was a significant correlation between serum sFas and the mean pulmonary artery pressure in patients with bilharzial cor pulmonale (r = 0.4, p < 0.01), but not in patients with COPD (r = 0.1, p = NS). CONCLUSIONS: Serum sFas levels are elevated in patients with schistosomal cor pulmonale and they are related to the severity of pulmonary hypertension. These findings suggest a role of apoptosis in schistosomal cor pulmonale.     

46例老年肺心病病理与临床对比分析

目的总结临床诊断老年肺心病的成功经验与失败教训。方法对４６例老年肺心病病例以病理解剖与临床资料对照的方法，从发病年龄、临床误诊率、临床漏诊率、病因、死亡原因、右室壁平均厚度与病程和死亡年龄的关系以及肺心病伴发冠心病等方面进行分析。结果本组老年肺心病平均发病年龄为６５岁。肺心病临床总误诊率达２７％，总漏诊率６％。肺心病病因以慢性支气管炎、肺气肿最常见占８４％。其死亡原因以呼吸衰竭和全心衰竭为主占５３％。平均右室壁厚度随肺心病病程和死亡年龄升高而增加。肺心病伴发冠心病者占４１％。结论以上结果表明老年肺心病临床误诊率较高，应严格掌握肺心病诊断标准以降低临床误诊率。积极降低慢性支气管炎和肺气肿的发病率仍是预防肺心病的重要环节。老年肺心病伴发冠心病的比率较高应引起重视。努力防治呼吸衰竭和心力衰竭能够有效的降低老年肺心病的死亡率。     

老年慢性肺源性心脏病急性加重期超敏C反应蛋白的临床价值

目的探讨超敏C反应蛋白CRP(hs-CRP)在老年慢性肺源性心脏病(肺心病)急性加重期的临床价值。方法选择2004年9月—2007年10月我院老年肺心病患者急性加重期64例和缓解期60例和健康组65例。检测并比较患者hs-CRP、白细胞(WBC)、血沉(ESR)、痰细菌培养等指标。结果肺心病患者hs-CRP、WBC和ESR均高于健康对照组(P0.05);肺心病患者急性加重期3个指标均高于缓解期(P0.05);急性加重期患者hs-CRP阳性率93.8%,远高于其他指标阳性率。结论hs-CRP检测有助于肺心病加重期感染状态的早期诊断,且其反映抗生素的治疗效果,有一定的临床使用价值。     

醛固酮与慢性肺源性心脏病肺动脉高压的相关性研究

目的 探讨血浆醛固酮与慢性肺源性心脏病肺动脉高压的关系。方法 选择90例慢性阻塞性肺病（COPD）患者分为COPD合并肺动脉高压组（n=30）、慢性肺源性心脏病肺心功能代偿期组（n=30）、慢性肺源性心脏病肺心功能失代偿期组（n=30）,采用放射免疫分析法测定3组患者的血醛固酮水平、多普勒超声检测肺动脉压力。结果 慢性肺源性心脏病肺心功能失代偿组血浆醛固酮浓度为（124.78±27.64）pg/ml,显著高于COPD合并肺动脉高压组（79.91±20.76）pg/ml及慢性肺源性心脏病肺心功能代偿期组（83.56±28.45）pg/ml,P〈0.05;血浆醛固酮浓度与肺动脉高压呈线性正相关（r=0.514,P〈0.05）,与血氧分压呈负相关（r=-0.248,P=0.019）。结论 醛固酮参与慢性肺源性心脏病患者肺动脉高压的发展。     

The hemodynamic changes in the course of the development from chronic obstructive pulmonary disease to cor pulmonale

Swan-Ganz catheterization was done in 36 cases of COPD (19 cases) and chronic cor pulmonale (17 cases) patients diagnosed clinically. The results showed that exercise might greatly increase the rate of early diagnosis of chronic cor pulmonale in 47.4%, which is significant in clinical practice, together with gamma-camera, echocardiography and vectorcardiography, it can further increase the early diagnostic rate of cor pulmonale. In these 36 cases, 13 cases had no pulmonary hypertension and in 7 cases of them pulmonary arterial mean pressure were still in normal range even after exercise. If only right heart catheterization was used to diagnose cor-pulmonale without above three noninvasive examinations mentioned above, a high rate of misdiagnosis cor pulmonale would be possible.     

Elevated plasma brain natriuretic peptide levels in chronic respiratory failure with cor pulmonale.

Elevated plasma brain natriuretic peptide (BNP) levels have been described in patients with congestive heart failure and acute myocardial infarction. We measured plasma BNP levels in patients with chronic respiratory failure to evaluate the correlation between plasma BNP levels and pulmonary haemodynamics. Plasma BNP levels were measured in 28 patients with chronic respiratory failure accompanied by three underlying diseases [14 with chronic obstructive pulmonary disease (COPD), seven with sequelae of pulmonary tuberculosis (sequelae Tbc) and seven with diffuse panbronchiolitis (DPB)] by immunoradiometric assay methods (IRMA). Twenty-one of 28 patients had already received oxygen supplementation and 16 of 21 patients were treated as outpatients with home oxygen therapy. Plasma BNP levels were significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (81.5 +/- 13.1 pg ml-1) compared to patients without cor pulmonale (13.3 +/- 2.7 pg ml-1, P < 0.001). As controls, plasma BNP levels in 10 patients with primary lung cancer were studied, and the results (3.5 +/- 1.0 pg ml-1) were not significantly different from those of patients with chronic respiratory failure without cor pulmonale. Plasma BNP levels in 12 healthy subjects were also studied, and the results (7.2 +/- 1.0 pg ml-1) were not significantly different from those of the control subjects. Plasma BNP levels showed a weak linear correlation with systolic pulmonary arterial blood pressure, estimated by Doppler echocardiography (r = 0.43; P = 0.068), but there was no significant correlation between BNP levels and the degree of hypoxaemia (r = 0.30; P = 0.138). Plasma atrial natriuretic peptide (ANP) levels in patients with chronic respiratory failure were also measured using the same samples. Plasma ANP levels were also significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (80.8 +/- 12.1 pg ml-1) compared to patients without cor pulmonale (26.1 +/- 4.4 pg ml-1, P = 0.003). A significant correlation was found between plasma BNP and ANP levels (r = 0.68; P < 0.001). Our results suggest that the plasma BNP or ANP level may be a useful indicator for detecting the presence of cor pulmonale in patients with chronic respiratory failure.     

慢性肺心病患者D-二聚体测定的临床意义及其与二氧化碳分压的相关性分析 8738

目的研究慢性肺心病患者血液D-二聚体（Ddimer）的变化及其与二氧化碳分压的相关性。方法选择慢性肺心病患者40例,测定血浆中D-二聚体的含量及二氧化碳分压,（PaC02）、同时对PaC02与D-二聚体水平进行相关性分析。并与健康人作对照。结果患者组血浆D-二聚体的含量显著高于正常对照组（P〈0．05）,且患者组PaC02与D-二聚体水平呈显著正相关。结论肺心病患者存在血液凝血状态异常,高碳酸血症是参与血液凝血状态异常的因素之一,D-二聚体可用于指导慢性肺心病患者治疗。     

慢性肺源性心脏病急性发作期的三重酸碱失衡

目的：探讨慢性肺源性心脏病（肺心病）急作发作期的酸碱失衡状况，方法：分析152例肺心病急性发作期患住院期间的461例次动脉血气，血清电解质检测结果和相关临床资料。计算阴离子间隙（AG）和潜在HCO3^-，根据酸碱失衡量化公式，判断酸碱失衡类型。结果：152例肺心病患，发生酸碱失衡133（87．5％），其中三重酸碱失衡15例（9．9％），都有多脏器损害。结论：危重肺心病患三重酸碱失衡，其主要处理原则是治疗原发病，维护脏器功能，维持PH值相对正常。     

环磷酸腺苷葡甲胺对慢性肺心病肺动脉高压的影响

目的:观察环磷酸腺苷葡甲胺静滴对肺心病心衰时肺动脉高压的影响。方法:对30例肺心病心衰肺动脉高压患者,应用环磷酸腺苷葡甲胺120 mg静滴,1次/d,疗程14天。治疗前后用彩色多普勒超声诊断仪测定平均肺动脉压力(mPAP)。结果:静滴环磷酸腺苷葡甲胺治疗10天及14天后mPAP均显著降低(P<0.01),治疗10天后与14天后相比:mPAP无明显变化(P>0.05)。结论:环磷酸腺苷葡甲胺静滴对降低肺动脉压力有显著作用,持续静滴之则肺动脉压力可维持在较低水平,对治疗肺心病心衰及改善预后有重要意义。     

重症慢性肺心病患者甲状腺激素水平观察

目的观察慢性肺心病急性加重期患者血清甲状腺激素变化,并探讨其临床意义。方法用放免法测定48例慢性肺心病急性加重期患者(试验组)及45例同期收治的慢性阻塞性肺疾病(COPD)患者(对照组)血清甲状腺激素(T3,T4,FT3,FT4)及促甲状腺素(TSH)水平,并进行比较。结果肺心病组血清T3,T4,FT3均明显低与对照组(P<0.01),FT4轻度下降,但差异无显著性(P>0.05),TSH水平两组比较差异无显著性(P>0.05)。结论慢性肺心病患者血清甲状腺激素水平的变化对肺心病急性加重期病情判断及其预后估计具有一定临床参考价值。     

各种检查技术在临床确诊的慢性肺心病诊断价值比较

本文通过对２０例临床确诊为慢性肺心病缓解期的右心导管，心电图、ｘ线胸片、超声心动图、部分心电向量图和放射性核素测定右心室射血分数的结果，对比各种检查手段对肺心病的诊断价值。慢性肺心病患者的肺动脉高压呈波动性和可逆性改变。研究结果表明２０例曾有心肺功能衰竭的患者，在病情稳定期，其中９例（４５％）静息状态下肺动脉平均压（ＰＡＰＭ）在正常范围。上述其它５种无创检查手段，对慢性肺心病缓解期患者的诊断符合率分别为：心电图９０％；ｘ线胸片８０％；心电向量图８６％；放射性核素所测ＲＶＥＦ６５％；超声心动图１００％。超声心动图对右心室肥厚与扩张的诊断敏感性优于其它无创手段，惜有１５％的失检率。     

注射用血塞通治疗慢性肺源性心脏病急性加重期60例临床观察

目的观察注射用血塞通在治疗慢性肺源性心脏病急性加重期的临床疗效。方法将入选病人分为治疗组60例、对照组52例。两组均给予抗感染、利尿、解痉平喘、止咳、祛痰、持续或间断低流量吸氧及对症处理，治疗组同时加用注射用血塞通静脉输注，每日1次，10d～15d为一疗程。结果治疗组总有效56例（93．33％）显著高于对照组的39例（75．00％）。结论注射用血塞通用于治疗慢性肺源性心脏病急性加重期有一定疗效。     

Lungenerkrankungen und Herzfunktion

The most severe cardiac sequel to lung disease is the load on the right ventricle due to pulmonary hypertension with the development of a cor pulmonale. This is characterized by hypertrophy and/or dilatation of the right ventricle because of a primary impairment of lung function and/or lung structure. The most important pathomechanisms for the development of pulmonary hypertension are vessel obliteration, mechanical lesions, primary vascular or extra-vascular inflammation and hypoxic vasoconstriction. Chronic obstructive pulmonary diesease (COPD) is one of the most important reasons for chronic cor pulmonale. A further very common reason is obstructive sleep apnea syndrome, especially if combined with a COPD. In this case, the prevalence of cor pulmonale can reach 80%. The development of a chronic cor pulmonale is the most striking negative prognostic factor for these patients. Only 30% of COPD patients with cor pulmonale survive longer than 5 years, and only early detection of the disturbances to respiration which might potentially lead to cor pulmonale and their subsequent therapy are able to improve the patient’s prognosis. Furthermore, pulmonary diseases may also have an impact on the left heart side in terms of an impairment of left heart function or by inducing severe arrhytmias. Thus, lung diseases may have both a significant impact on right and left heart performance.