慢性肺源性心脏病患者血浆环氧化酶2改变的意义

Clinical Significance of Plasma Cyclooxygenase-2 in Patients with Chronic Cor Pulmonale

目的了解慢性肺心病患者血浆环氧化酶2(COX-2)活性变化的临床意义。方法采用ELISA方法动态观察了65例慢性肺心病患者及30例健康对照者血浆COX-2活性。结果慢性肺心病患者血浆COX-2活性急性加重期(45.23±4.16)IU/L及缓解期(21.40±5.19)IU/L明显高于对照组(7.13±3.26)IU/L(P均<0.01);在急性加重期,患者心功能越差,血浆COX-2活性越高,心功能Ⅳ级者(62.98±8.15)IU/L>心功能Ⅲ级者(39.00±6.73)IU/L>心功能Ⅱ级者(12.84±5.20)IU/L及对照组(P均<0.01);另外,在急性加重期,患者COX-2活性与PaO2(5.08±2.65)kPa和pH值(7.29±0.31)均呈显著负相关(r分别为-0.65和-0.61,均为P<0.01),而与PaCO2(7.92±2.69)kPa呈显著正相关(r=0.71,P<0.01)。结论提示COX-2可能参与了慢性肺心病的发病过程,测定血浆COX-2活性,对评估慢性肺心病患者的病情变化及严重程度可能有一定的意义,拮抗COX-2的治疗可能有助于缓解患者的病情。

Objective To evaluate the clinical significance of plasma cyclooxygenase-2 （COX-2） in patients with chronic cor pulmonale. Methods The levels of plasma COX-2 in 65 patients with chronic cor pulmonale and 30 normal control subjects were measured by ELISA. Results The levels of plasma COX-2 in patients during acute phase （45.23±4.16） IU/L and recovery phase （21.40±5.19） IU/L were significantly higher than the normal subjects （7.13 ± 3.26） （P〈0.01）. During acute phase, the degree of cardiac failure is correlated with a high level of plasma COX-2. The level of COX-2 in patients with grade Ⅳ, Ⅲ and Ⅱ cardiac failure was （62.98 ± 8.15）,（39.0±6.73）, and （12.84 ± 5.2） IU/L, respectively. The value is significantly different from the normal control subjects （P〈0.01）. Furthermore, the levels of plasma COX-2 in the patients during acute phase showed a significant negative correlation with PaO2 （5.08± 2.65） kPa（r=-0.65,P〈0.01） and pH （7.29±0.31） （r=-0.61,P〈0.01）. The levels of plasma COX-2, however, was positively correlated with PaCO2 （7.92±2.69） kPa （r=0.71 ,P〈0.01 ）. Conclusion COX-2 may play an important role in the inflammatory process in patients with chronic cor pulmonale. Monitoring the levels of plasma COX-2 may be useful in the disease management.