肾上腺髓质素与肺动脉高压右室功能关系的研究

The relationship between the plasma concentrations of adrenomedullin and right ventricular function in patients with pulmonary hypertension

目的探讨肾上腺髓质素（ADM）在肺动脉高压（PH）右室功能损害、右室重塑病理生理过程中的作用和关系。方法PH组58例，非PH组23例，对照组20例。超声心动图分别测量右房室瓣前向血流及反流频谱、肺动脉前向血流频谱；ADM的测定采用非平衡法。结果PH组与非PH组及健康对照组相比，舒张早期右房室瓣最大流速（E）显著降低，舒张晚期右房室瓣最大流速（A）增加，E／A显著降低，肺动脉最大流速（PV）显著降低，右室等容舒张时间（IRT）、右室等容收缩时间（ICT）显著延长，Tei指数显著增加（P〈0．01）；血浆ADM浓度显著增高，与肺动脉收缩压正相关（r=0.678）；ADM与E、E／A、PV负相关（r=-0．438，-0．546，-0．514，P〈0．01），与A、IRT、ICT正相关（r=0．4Q9，0．504，0．322，P〈0．01～0．05）。结论ADM参与了肺动脉高压及右室功能减退的病理生理过程。

Objective To explore the relationship between the right ventricular function by echocardiography-derived indexes and the changes of concentrations of adrenomedullin（ADM） in patients with pulmonary hypertension（PH） .Methods The study group comprised 58 patients with PH,23 patients with no PH,20 subjects in the control group. Evaluated pulse-wave Doppler echocardiographic spectrum of tricuspid valve and pulmonary artery were respectively measured in patients with PH, non-PH and control subjects. The plasma concentrations of ADM were measured by radioimmunoassay. Results Compared with control group and non-PH,E and E/A tended to be decreased, A tended to be increased, PV tended to be decreased and IRT, ICT were significantly prolonged in patients with PH（ P 〈 0.01 ）. Plasma concentrations of ADM were significantly increased, compared with non-PH and normal subjects. There was positive relationship between plasma concentration of ADM and pulmonary artery pressure,and negative relationship among plasma concentration of ADM（ r = 0. 678） and E,E/A, PV（ r = - 0. 438, - 0. 546, - 0. 514, P 〈 0.01 ）. There was positive relationship among plasma concentration of and A, IRT, ICT （ r = 0. 409, 0.504,0.322,P〈0.01-0.05）.Conclnsion ADM may play an important role in developing of pulmonary hypertension and changes of right ventricular function in patients with PH.