慢性肺原性心脏病病理生理过程中肾上腺髓质素的变化

Investigate the effect of adrenomedullin on chronic cor pulmonale

目的 探讨肾上腺髓质素(ADM)在慢性肺原性心脏病(肺心病)的病理生理过程中 的作用。方法 选肺心病患者30例分别于急性加重期和缓解期采用放免法测定血浆ADM、内皮 素 1(ET)含量,同时检测动脉血气指标(PaO2、PaCO2、pH)和肺动脉收缩压(PASP),使用彩色多普 勒超声诊断仪测定,另取20名健康人同时测定ADM、ET含量,作为对照组。结果 肺心病患者发 作期和缓解期的ADM、ET含量均明显高于对照组(P<0.01),发作期明显高于缓解期(P<0.01); 肺心病患者血ADM含量与PASP呈显著正相关(OR=0.917,P<0.01),与PaO2呈负相关(OR= 0.642,P<0.05),发作期Ⅰ型呼吸衰竭与Ⅱ型呼吸衰竭患者血中ADM含量比较差异无显著性(P >0.05)。结论 ADM参与了肺心病的病理生理过程,缺氧可刺激ADM的合成和分泌,PaO2、ADM 对肺动脉压的调节有直接影响,并且在缺氧性肺动脉高压中对肺血管张力的调节具有一定的作用。

Objectiv To investigate the effect of adrenomedullin (ADM) on chronic cor pulmonale (CCP).Methods Serum concentration of ADM、ET by radioimmunoassay (RIA).PaO 2、PaCO 2、PH by blood gas assay,pulmonary artery systilic pressure (PASP) by color Doppler Supersonic diagnostic set was detected in the CCP patients in both acute and release phase 20 healthy adults entered the study as the contrast.Results (1)Tht levels of ADM and ET in CCP patients, whether in acute phase or in release phase,are much higher than that of the contrast (P<0.01).Moreover,the level of ADM in the acute stage is also higher than that in the release stage.(2)The concentration of serum ADM correlates significantly with PASP (OR=0.917,P<0.01),but reverse correlation whth PaO 2(OR=0.642,P<0.05).There is no significant difference in the comparison of ADM level in acute phase patients between type Ⅰand type Ⅱrespiratory failure.Conclusion ADM plays an important role in the development of CCP.Hypoxia,pulmonary hypertension induced the composition adn secretion of ADM.Together with hypoxia,ADM have somewhat effect on the modulation of PASP.