慢性阻塞性肺疾病缓解期患者血浆内皮素变化及其与心肺功能的关系

目的探讨内皮素（ＥＴ）－１在慢性阻塞性肺疾病（ＣＯＰＤ）发展中的临床意义。方法采用ＥＴ－１放射免疫直接法，血气分析仪和肺功能仪等测定３４例ＣＯＰＤ缓解期患者血浆不同部位ＥＴ－１浓度及其血流动力、心肺功能参数。结果肺动脉高压患者血浆ＥＴ－１明显高于肺动脉压正常者和健康人。肺动脉高压患者血浆ＥＴ－１与全肺阻力指数（ＴＰＲＩ）、体循环阻力指数（ＳＶＲＩ）、肺动脉平均压（ｍＰＡＰ）、体循环平均压（ＭＳＡＰ）和肺毛细血管楔压（ＰＣＷＰ）呈正相关，与ｐＨ值、混合静脉血氧分压（ＰｖＯ２）、混合静脉血氧含量（ＣｖＯ２）、小气道功能［５０％肺活量最大呼气流量（Ｖ５０）／２５％肺活量最大呼气流量（Ｖ２５）、（Ｖ２５／ＨＴ）％］呈负相关。肺动脉压正常者血浆ＥＴ－１与ＴＰＲＩ、ｍＰＡＰ、右心每搏功指数（ＲＶＳＷＩ）、左心每搏功指数（ＬＶＳＷＩ）呈正相关，与ｐＨ值、肺活量（ＶＣ）、最大通气量（ＭＶＶ）、Ｖ５０／Ｖ２５、（Ｖ２５／ＨＴ）％呈负相关。结论ＣＯＰＤ缓解期患者血浆ＥＴ－１增高可能仍是肺动脉高压形成的重要因素之一。血浆ＥＴ－１水平与心肺功能互相影响，ＥＴ－１的异常表达和释放可加速病情发展

Changes of plasma endothelin 1 level and its relation with cardiac and lung function in chronic obstructive lung disease

Objective To explore the clinical significance of plasma endothelin 1(ET 1) level in the progression of chronic obstructive lung disease. Methods Plasma ET 1 level was measured in 34 cases of chronic obstructive lung disease in different locations by using radioimmunoassay, and correlated with hemodynamic, cardiac and respiratory parameters. Results Plasma ET 1 level in patients with pulmonary hypertension (A group) was significantly higher than that of patients with normal pulmonary pressure (B group) and controls (C group). The plasma ET 1 level in A group had a significant positive correlation with TPRI, SVRI, mPAP, MSAP as well as PCWP and negative correlation with pH, PO 2, CO 2, 50 / 25 as well as ( 25 /HT)%. The plasma ET 1 level of B group had a significant positive correlation with TPRI, mPAP, RVSWI as well as LVSWI and negative correlation with pH, VC, MVV, 50 / 25 as well as ( 25 /HT)%. Conclusion High level of plasma ET 1 in chronic obstructive lung disease was one of the important factors that may induce pulmonary hypertension. There is interrelation between the plasma ET 1 level and cardiac and pulmonary function. The abnormity in ET expression and release can accelerate the progression of the disease.