老年慢性阻塞性肺疾病患者血浆内皮素－1含量与PaO_2、PaCO_2及肺动脉压的关系

A study on the correlation between plasma endothelin-1 in aged patients with chronic obstructive pulmonary diseases and their PaO_2,PaCO_2 and pulmonary arterial pressure

目的探讨血浆内皮素－１（ｅｎｄｏｔｈｅｌｉｎ－１，ＥＴ－１）在慢性阻塞性肺疾病（ｃｈｒｏｎｉｃｏｂｓｔｒｕｃｔｉｖｅｐｕｌｍｏｎａｒｙｄｉｓｅａｓｅ，ＣＯＰＤ）中的作用。方法应用放射免疫法测定４３例老年ＣＯＰＤ急性发作期患者和１５名健康对照者血浆ＥＴ－１水平，其中８例肺心病患者行右心微导管检测肺动脉压。结果ＣＯＰＤ患者和肺心病患者的血浆ＥＴ－１含量分别为５．２４±０．５０、５．８０±０．６６ｐｇ／ｍｌ，较健康对照组血浆ＥＴ－１含量（４．６５±０．６５ｐｇ／ｍｌ）明显升高（Ｐ值＜０．０１及０．００１）；血浆ＥＴ－１含量与ＰａＯ２呈显著性负相关（ＣＯＰＤ组：ｒ值＝－０．５８３，Ｐ值＜０．０１；肺心病组：ｒ值＝－０．６２７，Ｐ值＜０．００１），与ＰａＣＯ２呈显著性正相关（ＣＯＰＤ组：ｒ值＝－０．５１４，Ｐ值＜０．０５；肺心病组：ｒ值＝０．５９３，Ｐ值＜０．００１）；ＥＴ－１含量与肺动脉收缩压及平均压均存在正相关（ｒ值＝０．７２７及０．６８１，Ｐ值均＜０．０５）。结论血浆ＥＴ－１参与肺心病肺动脉高压的形成。

Objective The purpose of this study is to explore the role of endothelin-1(ET-1) in chronic obstructive pulmonary disease(COPD).Methods The level of plasma ET-1 was determined with radioimmunassay in 43 aged patients with COPD at during acute attack and 15 aged healthy subjects as control.Pulmonary arterial pressure was measured with catheterization of right heart in 8 of the 43 aged patients with cor pulmonale. Results Plasma ET-1 levels of patients with COPD and cor pulmonale were 5.24±0.50 and 5.80±0.66 pg/ml respectively.The levels were significantly higher than that in healthy subjects(4.65±0.65 pg/ml.P<0.01 and 0.001);The levels of plasma ET-1showed remarkable negative correlation with PaO2(COPD:r=-0.583,P<0.01;cor pulmonale:r=0.627,P<0.001 ) but remarkable positive correlation with PaCO2(COPD:r=0.514,P<O.05;cor pulmonale:r=0.593,P<0.001);The changes of systolic and mean pulmonary arterial pressure(sPAP and mPAP) had positive correlation with the level of plasma ET-1(r=0.727 and 0.681,all P<0.05).Conclusions It is suggested that plasma ET-1 may play a role in the formation of pulmonary hypertension in patients with cor pulmonale.Hypoxia and hypercapnia are the reasons which stimulate the releasing of ET-1.