克山病患者的临床特点及血管内皮功能

Clinical characteristics and vascular endothelium function in patients with Keshan disease

目的观察山东省慢型、潜在型克山病患者的临床特点和血管内皮功能,探讨机体内皮功能失调与克山病发生发展的关系。方法选择慢型、潜在型克山病患者57人分别进行心电图、X线胸片、超声心动图等检查,并采集克山病患者和病区健康人血浆,分别检测内皮素(ET)、一氧化氮(NO)、一氧化氮合酶(NOS)、诱导型NOS(iNOS)及结构型NOS(cNOS)含量。结果①慢型克山病患者X线下100%都有心脏增大,且以重度增大多见;90.9%有心电图异常改变,且往往几种异常同时并存;心脏超声示心功能明显降低。潜在型克山病心脏轻度增大者多见,而且心电图往往只有一种改变。②克山病患者ET水平明显高于病区健康人(P<0.01),心功能越差,ET升高越明显(P<0.01)。③NO、NOS及iNOS,克山病患者明显高于病区健康人(P<0.01),且慢型克山病患者高于潜在型克山病患者。结论ET、NO水平的变化可能作为一种中间环节参与了克山病的发病机制;心功能不同,血浆ET、NO升高的程度也不同;ET、NO可作为克山病病情严重程度的预测指标。

Objective To observe the clinical characteristics and vascular endothelium function inpatients with Keshan disease(KSD) in Shandong Province, and to study the relationship between the disorder ofendothelia function and genesis of KSD. Methods Fifty-seven KSD patients were chosen to undergo ECG, X-rayand UCG, respectively. The plasma of KSD patients and healthy subjects in KSD areas was collected to determineendothelin(ET), nitric oxide(NO), nitric-oxide synthase(NOS), inducible NOS(iNOS) and constructive NOS(cNOS)by different ways. Results ①Among 33 chronic KSD patients, 90.9% had ECG change, and several abnormalitiescoexisted; And the chest X-rays showed that 100% of hearts enlarged and most of the enlargement was in a severedegree. Among 24 potential KSD patients, 66.7% presented abnormal ECG- only one ECG abnormality; the chestX-rays showed that the heart slightly enlarged. ②The ET level in KSD patients was obviously higher than that innon-KSD areas (P < 0.01). And the worse the hearts function, the higher the ET. ③The contents of NO, NOS,iNOS in KSD patients were obviously higher than those of healthy people (P < 0.01), and those of chronic patientshigher than those of potential patients (P < 0.01). Conclusions The changes of ET and NO may contribute to theoccurrence of KSD as intermediate links. In patients with different heart function, the values of serum ET and NOare different, which can be used as markers for predicting the degree of KSD.