吸入外源性一氧化氮对急性高原病患者内皮源性血管舒缩因子的影响

The effect of inhaled nitric oxide on endothelium-derived angiokinetic factors in patients with acute high altitude disease

目的 了解外源性一氧化氮对急性高原病患者内皮源性血管舒缩因子的影响。方法 将47例急性高原病患者随机分为两组，常规药物组23例给予吸氧、氨茶碱、地塞米松、速尿等药物治疗；一氧化氮组24例仅吸入由海拔3658m空气平衡的0．001％一氧化氮气体，每天上午和下午各1次，每次1h。观察两组治疗前后血清一氧化氮及血浆内皮素、血栓素B2和6-酮-前列腺素F1a含量，以及临床症状的变化情况。结果 常规药物组和一氧化氮组治疗后内皮素[（78±8）和（69±5）ng／L]、血栓素B2[（87±13）和（73±8）ng／L]、内皮素／一氧化氮[（26．7±1．5）×10^3和（21．8±1．1）×10^3]、血栓素B2／6-酮-前列腺素F1a（0．84±0．36和0．58±0．11）及临床症状评分[（2．4±1．6）和（1．8±1．3）分]与治疗前内皮素[（83±8）和（84±4）ng／L]、血栓素B2[（102±16）和（103±13）ng／L]、内皮素／一氧化氮[（35．0±2．7）×10^3和（36．3±3．1）×10^3]、血栓素B2／6-酮-前列腺素F1a（1．28±0．38和1．24±0．28）及临床症状评分[（4．4±2．3）和（4．4±2．0）分]比较显著下降；治疗后一氧化氮[（2880±537）和（3167±192）μg／L]、6-酮-前列腺素F1a[（122±46）和（128±15）ng／L]与治疗前一氧化氮[（2372±144）和（2313±188）μg／L]、6-酮-前列腺素F1a[（86±28）和（86±13）ng／L]比较显著升高。一氧化氮组与常规药物组治疗后的结果比较，也表现出相同规律。结论 吸入高原现场空气平衡的外源性一氧化氮能使急性高原病患者内皮源性血管舒缩因子显著下降，对患者的康复具有积极的作用。

Objective To study the effect of inhaled nitrogen monoxidum （NO） on endotheliumderived angiokinetic factors including NO, endothelin （ET）, thromboxane B2 （TXB2 ） and 6-keto- prostaglandin F1a （6-Keto-PGF1a） in patients with acute high altitude disease. Methods Forty-seven patients with acute high altitude disease were selected and divided into two groups randomly： twenty-three cases as a routine medical treatment group, for which oxygen, aminophylline, dexamethasone and furesemide were used, while 24 cases as a NO treatment group, for which only inhalation of 0.001% NO gas with air balanced in plateau （altitude 3658 m） ,were given twice daily （AM and PM each for an hour）. The level of serum NO, ET, TXB2 and 6-Keto-PGF1a, were measured, and the changes of clinical symptoms were scored using the Lake Louise acute high altitude disease scoring. Results In the two groups, the level of ET [ （78 ±8） and （69 ±5） ng/L] ,TXB2[ （87 ± 13） and （73 ±8） ng/L] ,ET/NO [ （26.7 ± 1.5）×10^3 and （21.8 ± 1.1 ）×10^3 ], TXB2/6-Keto-PGF1a （ 0. 84 ± 0. 36 and 0. 58 ± 0. 11, clinical symptom score 2. 4 ± 1.6 and 1.8 ± 1.3 ） after treatment were decreased significantly as compared to the levels of ET [ （ 83 ± 8 ） and （84±4） ng/L],TXB2[（102 ± 16） and （103 ±13） ng/L],ET/NO [（35.0 ±2.7） ×10^3 and （36. 3 ±3. 1 ） ×10^3 ], TXB2/6-Keto-PGF1a （ 1.28 ± 0. 38 and 1.24 ± 0. 28 ）, clinical symptom score （4. 4 ± 2. 3 and 4. 4 ± 2. 0） before treatment. After treatment, the level of NO [ （2880 ±537 ） and （3167 ± 192） μg/L] and 6-Keto-PGF1a[ （ 122 ±46） and （ 128 ± 15） ng/L] were significantly higher than the level of NO [（2372±144） and （2313 ± 188）μg/L] and 6-Keto-PGF1a [ （86 ±28） and （86 ± 13） ng/L] before treatment. Conclusion Inhaled NO is an effective treatment for high altitude disease in plateau, probably by modulating the angiokinetic factors.