丹参阻抑慢性肺源性心脏病肺血管内皮细胞损伤的效应与途径

Effect of salvia miltiorrhiza bunge in inhibiting the injury of pulmonary vascular endothelial cell in chronic cor pulmonale and the pathway

目的:探讨丹参注射液治疗慢性肺源性心脏病(简称肺心病)时对肺血管内皮细胞损伤的保护作用,以及对血管内皮细胞分泌功能的影响。方法:选择1999-02/08吉林大学第四医院呼吸内科收治的慢性肺心病急性发作期患者44例。随机分为丹参组和对照组,各22例。对照组给予一般常规治疗,丹参组在一般常规治疗同时加用丹参注射液静脉滴注,50g/L葡萄糖注射液250mL中加丹参注射液20mL,1次/d,连用14d。两组治疗前后均采血测定静脉血循环内皮细胞、血浆内皮素-1。采用ABL-520型血液气体酸碱分析仪检测动脉血酸碱度、动脉血氧分压、动脉血二氧化碳分压。结果:纳入患者44例,均进入结果分析。①循环内皮细胞:丹参组治疗后较治疗前下降明显[(0.87±0.23),(1.27±0.26)×107L-1,t=7.99,P=0.000];对照组治疗后较治疗前下降不明显[(1.09±0.28),(1.19±0.26)×107L-1,t=2.00,P=0.059];治疗后丹参组与对照组比较下降明显(t=4.03,P=0.000)。②内皮素-1:丹参组治疗后较治疗前下降明显[(70±14),(105±26)ng/L,t=8.64,P=0.000];对照组治疗后较治疗前下降不明显[(88±23),(99±24)ng/L,t=2.00,P=0.059];治疗后丹参组与对照组比较下降明显(t=3.99,P=0.000)。③直线相关分析:循环内皮细胞与内皮素-1呈显著正相关(r=0.733,P<0.01);与动脉血氧分压呈显著负相关(r=-0.751,P<0.01);而与动脉血酸碱度、动脉血二氧化碳无明显相关性(r=-0.115,0.237,P>0.05)。结论:丹参对于慢性肺心病患者的肺血管内皮细胞具有保护作用,使其免受损伤和对抗内皮素-1,使内皮素-1合成减少,或同时使内皮素-1灭活增加,从而达到阻抑或减轻肺血管内皮细胞损伤而带来的一系列病理反应。

AIM： To investigate the protective effect of salvia miltiorrhiza bunge （SMB） on injured pulmonary vascular endothelial cell （VEC） in chronic cor pulmonale, and the effect of SMB on secretory function of vascular endothelial cell. METHODS： Totally 44 patients with chronic cor pulmonale were selected from Department of Respiratory Disease, Fourth Hospital of Jilin University from February to August 1999. All patients were randomly divided into SMB group and control group with 22 in each group. Patients in control group were treated routinely, but patients in SMB group were treated with the combination of routine thertapy and venous drip injection of 20 mL SMB parenteral solution, and the mixture of 250 mL glucose solution （50 g/L） and 20 mL SMB solution once a day for totally 14 days. Blood was collected pre- and post-treatment to assay the value of circulating endothelial cells （CEC） and plasma endothelin-1 （ET-1）. In addition, pH, arterial pO2 and arterial blood pCO2 were measured with ABL-520 blood gas acid and base analysis meter. RESULTS： Totally 44 patients entered the final analysis. （1） CEC： It was decreased obviously in SMB group after treatment as compared with that before treatment [（0.87±0.23）, （1.27±0.26）×10^7L^-1, t=7.99, P=0.000], but decrease was not obvious in control group after treatment [（1.09±0.28）, （1.19±0.26）×10^7L^-1, t=2.00, P=0.059]. After treatment, CEC was decreased obviously in SMB group as compared with that in control group （t=4.03, P=0.000）. （2） ET-1： It was decreased obviously in SMB group after treatment as compared with that before treatment [（70±14）, （105±26）×10^7 L^-4, t=8.64, P=0.000], but decrease was not obvious in control group after treatment [（88±23）, （99±24）×10^7L^-1, r=2.00,P=0.059]. After treatment, ET-1 was decreased obviously in SMB group as compared with that in control group （t=3.99, P=0.000）. （3） Linear correlation analysis： CEC was positive correlation with ET-1 （r=0.733, P〈0.01）, and negative correlation with pO2 （r=-0.751,P〈0.01）, but no correlation with pH and PaCO2 （r=-0.115, 0.237, P 〉 0.05）. CONCLUSION： SMB can protect VEC in chronic cor pulmonale, prevent VEC from injuring and resist ET-1, decreases the compound of ET-1, and increases the inactivation of ET-1. Therefore, a series of pathologic process caused by the injured VEC can be prevented and eliminated.