慢性肺心病患者血浆尾加压素Ⅱ、肾上腺髓质素水平的变化及家庭氧疗的影响

The changes of plasma urotensin Ⅱ,adrenomedullin levels in chronic cor pulmonale and the intervention studies with home oxygen therapy

目的探讨慢性肺心病患者血浆肾上腺髓质素(ADM)和尾加压素Ⅱ(UⅡ)的变化及其临床意义,并观察家庭氧疗对ADM、UⅡ水平的影响。方法测定84例慢性肺心病患者急性加重期和缓解期血浆ADM、UⅡ、内皮素-1(ET-1)水平及动脉血氧分压(PaO2)、平均肺动脉压(mPAP),并与40例当地健康人对照。出院后42例患者接受家庭氧疗(治疗组),34例未氧疗(对照组),随访6周后复测上述指标。结果急性加重期和缓解期血浆ADM、UⅡ均显著高于健康正常组(P均<0.01),急性发作期均高于缓解期(P均<0.01)。急性期和缓解期血浆ADM、UⅡ均与PaO2呈显著负相关,与ET-1及mPAP呈显著正相关。6周后,治疗组ADM、UⅡ、mPAP均显著低于对照组(P均<0.05),而PaO2显著高于对照组(P<0.05)。结论血浆ADM、UⅡ可能参与了肺心病的病理生理过程。氧疗可能通过对ADM、ET-1、UⅡ水平起调节作用进而改善症状及提高患者生存质量。

Objective To observe the changes of plasma urotensin R （ UⅡ ） , adrenomedullin （ADM） levels in chronic eor pulmonale and their clinical implications, the clinical effect with home oxygen therapy and its effect on plasma U Ⅱ and ADM. Methods Plasma U Ⅱ , ADM, ET-1 levels and PaO2, mPAP of 84 patients with chronic eor pulmonale in acute exacerbation and remission and 65 control subjects were measured. Discharged from hospital, 42 patients received home oxygen therapy （treatment group） , 34 non-oxygen therapy （ control group） both followed for 6 weeks on above-mentioned targets. Results The levels of ADM and U Ⅱ in the acute and remission stages of car pulmonale groups were both significantly higher than the control group. ADM and U Ⅱ in the acute stage were both significantly higher than those in remissionstage. In the two stages, Plasma ADM, UⅡ were negatively correlated with PaO2 , positivaly correlated with ET-1 and mPAP. 6 weeks later, ADM, UⅡ , mPAP in the treatment group were significantly lower and PaO2 significantly higher （ P 〈 0.05 ） than in the control group （ P all 〈 0. 05 ）. Conclusion ADM and UⅡ are involved in the pathophysiolagical process of chronic cor pulmonale. Oxygen therapy may regulate the levels of ADM, ET-1, U Ⅱ , and improve the symptoms and the quality of life of patients.