高原地区慢性肺心病患者血浆肾上腺髓质素和脑钠素变化的研究

目的探讨高原地区慢性肺心病患者血浆肾上腺髓质素(ADM)和脑钠素(BNP)的变化及其临床意义。方法用放射免疫分析法测定44例高原肺心病患者急性发作期和缓解期血浆ADM和BNP水平,与内皮素1(ET1)、动脉血氧分压(PaO2)、右室射血前期时间与肺动脉血流加速时间比值(RVPEP/AT)进行相关分析,并与20例当地健康人作对照。结果肺心病组急性发作期和缓解期血浆ADM〔分别为(38.8±7.2)ng/L、(26.2±5.3)ng/L〕和BNP水平〔(81.4±13.8)ng/L、(58.9±9.3)ng/L〕均显著高于健康对照组〔分别为(15.0±3.2)ng/L、(38.6±3.4)ng/L,P均<0.01〕,急性发作期均高于缓解期(P均<0.01)。肺心病组急性发作期和缓解期血浆ADM与PaO2呈显著负相关(r急=0.826,P<0.01;r缓=0.783,P<0.01),与ET1(r急=0.755,P<0.01;r缓=0.668,P<0.01)及RVPEP/AT(r急=0.788,P<0.01;r缓=0.734,P<0.01)呈显著正相关;血浆BNP也与PaO2呈显著负相关(r急=0.787,P<0.01;r缓=0.554,P<0.01),与ET1(r急=0.725,P<0.01;r缓=0.679,P<0.01)及RVPEP/AT(r急=0.771,P<0.01;r缓=0.722,P<0.01)呈显著正相关。结论ADM和BNP可能参与了高原肺心病的病理生理过程,并在其中具有代偿作用。

Study on the clinical significance of plasma adrenomedullin and brain natriuretic polypeptide in the patients with chronic cor pulmonale on highland

OBJECTIVE: To study the clinical significance of plasma adrenomedullin (ADM) and brain natriuretic polypeptide (BNP) in the patients with chronic cor pulmonale on highland (HACCP). METHODS: The levels of ADM and BNP in plasma of 44 patients with HACCP in the acute and in the remission stages were determined with radioimmunoassay. Their correlations with partial pressure of oxygen in arterial blood (PaO(2)), endothelin-1 (ET-1), and the ratio of right ventricular pre-ejection time to the pulmonary flow acceleration time (RVPEP/AT), which reflected the degree of pulmonary hypertension, were investigated. Twenty healthy subjects served as a normal control group. RESULTS: The levels of ADM (38.8+/-7.2)ng/L and (26.2+/-5.3)ng/L] and BNP (81.4+/-13.8)ng/L and (58.9+/-9.3)ng/L] in the acute and remission stages of cor pulmonale groups were both significantly higher than those in the normal control group (15.0+/-3.2)ng/L, (38.6+/-3.4)ng/L, respectively, all P<0.01]. The levels of ADM and BNP in acute stage were both significantly higher than those in remission stage (both P<0.01). In the acute and in the remission stages, the levels of ADM in plasma were negatively correlated with PaO(2) (r(a)=-0.826, P<0.01; r(r)=-0.783, P<0.01), positively correlated with ET-1 (r(a)=0.755, P<0.01; r(r)=0.668, P<0.01) and RVPEP/AT ratio (r(a)=0.788, P<0.01; r(r)=0.734, P<0.01). In the acute and in the remission stages, the levels of BNP in plasma were negatively correlated with PaO(2) (r(a)=-0.787, P<0.01; r(r)=-0.554, P<0.01), positively correlated with ET-1 (r(a)=0.725, P<0.01; r(r)=0.679, P<0.01) and RVPEP/AT ratio (r(a)=0.771, P<0.01; r(r)=0.722, P<0.01). CONCLUSION: The study suggests that ADM and BNP are involved in the pathophysiological process of HACCP in the patients and may play a compensatory role in the disease.