肾上腺髓质素与肺动脉高压右室功能关系的研究

目的探讨肾上腺髓质素（ADM）在肺动脉高压（PH）右室功能损害、右室重塑病理生理过程中的作用和关系。方法PH组58例,非PH组23例,对照组20例。超声心动图分别测量右房室瓣前向血流及反流频谱、肺动脉前向血流频谱;ADM的测定采用非平衡法。结果PH组与非PH组及健康对照组相比,舒张早期右房室瓣最大流速（E）显著降低,舒张晚期右房室瓣最大流速（A）增加,E／A显著降低,肺动脉最大流速（PV）显著降低,右室等容舒张时间（IRT）、右室等容收缩时间（ICT）显著延长,Tei指数显著增加（P〈0．01）;血浆ADM浓度显著增高,与肺动脉收缩压正相关（r=0.678）;ADM与E、E／A、PV负相关（r=-0．438,-0．546,-0．514,P〈0．01）,与A、IRT、ICT正相关（r=0．4Q9,0．504,0．322,P〈0．01～0．05）。结论ADM参与了肺动脉高压及右室功能减退的病理生理过程。

The relationship between the plasma concentrations of adrenomedullin and right ventricular function in patients with pulmonary hypertension

Objective To explore "he relationship between the right ventricular function by echocardio-graphy-derived indexes and the changes of concentrations of adrenomedullin(ADM) in patients with pulmonary hy-pertension(PH). Methods The study group comprised 58 patients with PH,23 patients with no PH,20 subjects in the control group. Evaluated pulse-wave Doppler echocardiographic spectrum of tricuspid valve and pulmonary artery were respectively measured in patients with PH,non-PH and control subjects. The plasma concentrations of ADM were measured by radioimmunoassay. Results Compared with control group and non-PH,E and E/A tended to be decreased,A tended to be increased,PV tended to be decreased and IRT,ICT were significantly prolonged in patients with PH( P < 0.01). Plasma concentrations of ADM were significantly increased, compared with non-PH and normal subjects. There was positive relationship between plasma concentration of ADM and pulmonary artery pressure, and negative relationship among plasma concentration of ADM( r = 0. 678) and E,E/A,PV( r=-0.438, - 0. 546, -0.514,P<0.01). There was positive relationship among plasma concentration of and A, IRT, ICT ( r = 0. 409, 0.504,0. 322 ,P<0.01~0.05). Conclusion ADM may play an important role in developing of pulmonary hypertension and changes of right ventricular function in patients with PH.