先天性心脏病肺动脉高压病人血浆肾上腺髓质素含量测定及其与一氧化氮的关系

①目的探讨先天性心脏病肺动脉高压病人血浆肾上腺髓质素(ADM)的含量变化及其与一氧化氮(NO)的关系.②方法根据肺动脉压水平将40例病人分为肺动脉高压组和对照组,用放射免疫分析法测定血浆ADM含量;单一试剂比色法测定血浆NO含量.③结果肺动脉高压组肺动脉和肺静脉血浆ADM含量均明显高于对照组(t=3.814,3.194,P＜0.01,0.05),肺动脉血浆NO浓度亦明显高于对照组(t=3.044,P＜0.01);全部病人肺静脉血浆ADM含量明显低于肺动脉(t=7.440,P＜0.001);肺动脉高压组肺动脉中ADM和NO血浆含量与肺动脉收缩压均呈正相关(r=0.50,0.49,P＜0.01),在肺静脉中ADM含量与肺动脉收缩压亦呈正相关(r=0.54,P＜0.01),肺动脉高压组血浆NO与ADM的含量呈正相关(r=0.35,P＜0.05).④结论先天性心脏病肺动脉高压发生发展过程中ADM升高,NO可能介导ADM的扩血管作用.

CHANGES OF ADRENOMEDULLIN AND NITRIC OXIDE PLASMA LEVEL IN PATIENTS WITH CONGENITAL HEART DISEAS ES COMPLICATED BY PULMONARY HYPERTENSION AND THE RELATIONSHIP BETWEEN THEM

Objective To explore the changes of the adrenomedullin(ADM) concentration in patients with congenital heart diseases complicated by pulmonary hypertension(PH) and the correlation of ADM with nitric oxide(NO). Methods 40 patients were divided into PH group and control group according to their pulmonary blood pressure above or under 4kPa determined by UCG. Plasma ADM was measured by specific radioimmunoassay,while plasma NO was measured by colorimetric assay. Results In both pulmonary artery and pulmonary vein, plasma levels of ADM were significantly higher in PH group than that in control group ( t=3.814, 3.194, P <0. 01, 0.05 ). Plasma levels of NO in pulmonary artery increased significantly in PH group than that in control group ( t=3.044,P <0.01). The plasma levels of ADM were significantly lower in pulmonary vein than that in pulmonary artery in all patients ( t=7.440, P < 0.001) . The plasma levels of ADM, as well as plasma levels of NO, were significantly correlated with pulmonary arterial systolic pressure( r=0.50, 0.49 , P <0.01). The pulmonary vein plasma levels of ADM were also significantly correlated with pulmonary arterial systolic pressure ( r= 0.54 ,P < 0.01 ).In PH group, the plasma levels of ADM were correlated with plasma levels of NO ( r=0.35,P < 0.05 ). Conclusion Plasma levels of ADM increased in the development and maintenance of pulmonary hypertension in patients with congenital heart diseases. Probably ADM exerts its action of vasodilator activity mediated by NO.