L-精氨酸对肺源性心脏病急性加重期患者的影响

Effects of L-arginine in cor pulmonale during acute exacerbation

目的了解L-精氨酸（L—Arginnine，L—Arg）对肺源性心脏病急性加重期患者血浆中一氧化氮（nitric oxide，NO）、内皮素1（endothelin-1，ET-1）及尾加压素Ⅱ（urotensin-Ⅱ，U-Ⅱ）3种血管活性肽合成分泌的影响，以寻求理想的降低肺动脉高压（PAH）的药物。方法选取肺源性心脏病急性加重期患者60例，随机分为两组：L-Arg治疗组及常规治疗组，每组各30例。另选30例健康者作为对照组。常规治疗组予抗感染、止咳平喘等治疗；L—Arg治疗组除此之外，加用L—Arg20g入100ml 5％葡萄糖液中，60滴／min，每日1次，连续5d。两组均于用药前及用药5d后监测NO、ET-1、U-Ⅱ、肺动脉压、血压、心率、尿素氮（BUN）、肌酐（Cr）及血气等指标。结果L—Arg组及常规组治疗前的PaO2、NO均比对照组低，肺动脉压、心率、ET-1和U-Ⅱ均比对照组高（P〈0．05）；L—Arg组治疗5d后BUN、NO较同组治疗前及常规组治疗5d后均明显升高，肺动脉压、ET-1较同组治疗前及常规组治疗5d后均明显降低，U-Ⅱ比同组治疗前有明显下降，但两组治疗5d后的比较无统计学差异。结论L—Arg可调节NO、ET、U—Ⅱ的合成和分泌，有效的降低PAH。

Objective To understand the effects of synthesis and secretion of L-arginine（L-Arg） to nitric oxide（NO）, endothelin-1 （ET-1） and urotensin- Ⅱ （ U- Ⅱ ） in cor pulmonale during acute exacerbation for the ideal medication of reducing pulmonary artery hypertension（PAH）. Methods Sixty cases of cor pulmonal during acute exacerbation were randomly divided into L-Arg treatment group and routine treatment group,30 cases in each group. In addition, healthy control group consisted of 30 cases. The patients in routine treatment group were given by treatment controlling the infection. The patients in L-Arg treatment group were added to L-Arg besides the treatment in routine group. L-Arg 20 g was added to 5% glucose 100 ml, sixty drops per minute,one time per day, continued five days. NO, ET-1, U- Ⅱ , pulmonary arterial pressure, blood pressure, heart ratio, BUN, Cr and pH, PaO2, PaCO2. HCO3^-, were monitored before treatment and after treating five days in L-Arg treatment group and routine treatment group. Results PaO2, NO before treatment in L-Arg group and routine group were significantly lower than those of control group. Pulmonary arterial pressure,heart ratio, ET-1 and U-Ⅱ were significantly higher（ P 〈0.05）;after treating five days BUN,NO in L-Arg group were significantly higher than before treatment in the same group and after treating five days in routine group,pulmonary arterial pressure and ET-1 were significantly lower than before treatment and after treatment in routine group. U- Ⅱ after treating five days in L-Arg group was significantly lower than before treatment in the same group,there were no differences about U-Ⅱ after treating five days between two groups. Conclusions L-Arg can adjust synthesis and secretion of NO, ET-1, and U-Ⅱ can efficiently decrease PAH.