高原地区慢性肺源性心脏病患者肺血管活性因子水平变化及其与肺动脉高压的关系

目的探讨高原慢性肺心病（HACCP）患者肺血管活性因子变化及其与肺动脉高压（PAH）的关系。方法采用放射免疫分析法检测65例HACCP急性加重期和60例缓解期患者血浆中介素（IMD）、肾上腺髓质素（ADM）、内皮素-1（ET-1）含量，用血气分析仪测定动脉血氧分压（PaO2），用多普勒超声心动仪测定肺动脉血流频谱，计算平均肺动脉压（mPAP），并与40例当地健康人比较。结果HACCP急性加重期和缓解期患者血浆IMD、ADM、ET-1及mPAP分另U为（156．6±15．2）pg／mL、（71．7±6．3）pg／mL、（90．8±9．5）ng／L、（44．7±6．5）mmHg和（112．3±12．5）pg／mL、（47．8±4．2）pg／mL、（64．9±6．6）ng／L、（34．9±5．2）mmHg]较对照组分别为（60．6±9．8）pg／mL、（21．8±3．2）pg／mL、（34．8±4．3）ng／L、（21．2±3．4）mmHg]显著升高，Pa02分别为（36．4±5．3）mmHg、（48．8±4．4）mmHg]较对照组（68．2±3．5）mmHg]显著降低（均P〈0．01）。急性加重期与缓解期比较亦有非常显著性差异（均P〈0．01）。急性加重期及缓解期患者mPAP与血浆IMD、ADM、ET-1均呈显著正相关（分别r=0．688、0．719、0．723及0．569、0．591、0．627，均P〈0．01），PaO，与IMD、ADM、ET-1均呈显著负相关（分别r=-0．625、-0．698、-0．638及-0．641、-0．536、-0．562，均P〈0．01）。结论IMD、ADM、ET-1共同参与了HACCP患者PAH形成的病理生理过程，其比例失衡可能是导致高原肺心病低氧性PAH发生发展的重要因素。

Changes of pulmonary vasoactive factors and its relation with pulmonary arterial hypertension in patients with chronic cor pulmonale at high altitude area

Objective To assess the changes of pulmonary vasoactive factors and its relation with pulmonary arterial hypertension (PAH) in patients with chronic cor pulmonale at high altitude (HACCP) area. Methods The levels of plasma intermedin(IMD), adrenomedulin(ADM), endothelin-1 (ET-1), partial pressure of oxygen in artery blood(PaO2) ,and mean pulmonary arterial pressure(mPAP)were measured in 65 patients with exacerbation and 60 patients with stable HACCP,the upper mentioned parameters were meated in 40 healthy peoples. Results Levels of plasma IMD,ADM,ET-1,and mPAP in patients with exacerbation and stable HACCP (156.6±15.2)pg/mL,(71.7±6.3)pg/mL,(90.8±9.5)ng/L,(44.7±6.5)mm Hg and(112.3±12.5)pg/mL,(47.8±4.2)pg/mL,(64.9±6.6)ng/L,(34.9±5.2)mm Hg,respectively] were both markedly higher,and PaO2(36.4±5.3)mm Hg,(48.8±4.4)mm Hg, respectively] was both markedly lower than those in the the normal control subjects(60.6±9.8)pg/mL,(21.8±3.2)pg/mL,(34.8±4.3)ng/L,(21.2±3.4)mm Hg, (68.2±3.5)mm Hg , respectively] (all P<0.01),all parameters in patients with exacerbation HACCP were different significantly compared with those in patients with stable HACCP (all P<0.01). The mPAP was both positively correled with IMD、ADM、ET-1 (r＝0.688,0.719,0.723 and 0.569,0.591,0.627,respectively ,all P＜0.01), and PaO2 was both netatively correlated with IMD,ADM,ET-1(r＝-0.625,-0.698,-0.638 and -0.641,-0.536,-0.562,respectively,all P＜0.01)in patients with exacerbation and stable HACCP.Conclusion IMD,ADM and ET-1 may play important roles in mechanism of PAH in HACCP. Imbalance of these factors have great effects on the development of hypoxic pulmonary hypertasion in HACCP.