慢性高原病血清血管生成因子的变化

CHANGES OF SERUM ANGIOGENESIS IN PATIENTS WITH CHRONIC MOUNTAIN SICKNESS

目的:慢性高原病(CMS)以红细胞过度增生、肺动脉高压和低氧血症为特征,但对该病的发病机制尚未完全阐明。本研究以CMS患者和高原世居藏族健康人为研究对象,探讨血管生成相关因子在CMS发生、发展过程中的作用。方法:以海拔4 380 m地区的CMS患者35例(CMS组)和高原世居藏族健康人13名(世居组)为研究对象,西宁地区(海拔2 260 m)世居健康人17名为对照组,采用固相双抗体夹心ELISA方法测定血清碱性成纤维生长因子(bFGF)、血管内皮生长因子(VEGF)和血小板源生长因子(PDGF)浓度,同时测定血红蛋白(Hb)浓度、红细胞比积(Hct)和动脉血氧饱和度(SaO2)。结果:血清bFGF浓度CMS组(107.26±7.86)ng/L与世居组(37.01±9.16)ng/L和对照组(40.58±5.34)ng/L比较,有显著差异(P<0.01);血清PDGF浓度CMS组(630.18±9.89)ng/L与世居组(292.16±6.88)ng/L和对照组(287.68±8.33)ng/L比较,有显著差异(P<0.01);血清VEGF浓度CMS组(543.74±6.76)ng/L与世居组(125.51±7.26)ng/L和对照组(76.26±4.60)ng/L比较,有显著差异(P<0.01),世居组与对照组比较,也有显著差异(P<0.01)。CMS患者血红蛋白(Hb)浓度与其血清bFGF、PDGF和VEGF水平均呈正相关(P<0.01)。血清bFGF、PDGF、VEGF之间亦呈正相关(P<0.01)。结论:CMS患者血清bFGF、PDGF和VEGF水平显著高于居住在同一个海拔高度的健康人和居住在西宁地区的健康人,提示CMS患者血管生成因子过度表达,血管新生可能是CMS病理生理的重要方面;血清VEGF水平高原健康人高于西宁地区健康人,提示VEGF高表达可能是高原健康人对高原环境适应机制的组成部分;CMS患者Hb浓度与其血清bFGF、PDGF和VEGF水平均呈正相关,提示在CMS患者中,bFGF、PDGF和VEGF可能与红细胞生成有关。

Aim： The clinical manifestation of chronic mountain sickness（CMS） is polycythemia, pulmonary hypertension and mionectic blood. However, the pathogenesis of it is not identified now. So it is necessary to investigate the effects of the angiogenic growth factors on the pathophysiologic development of CMS. Methods： The serum levels of basic fibroblast growth factor（ bFGF）, platelet-derived growth factor（eDGF） and vascular endothelial growth factor（VEGF） in 13 healthy Tibetan natives （Native）, 17 healthy people in Xining（contml group） and 35 CMS patients were determined by quantitative sandwich enzyme immunoassay. Meanwhile, the levels of Hb,Hct and SaO2 were determined. Results： The serum levels of bFGF （ 107.26 ±7.86） ng/L, PDGF（ 630.18 ±9.89） ng/L and VEGF （ 543.74 ±6.76） ng/L in CMS were significantly higher than those in Natives（37.01 ±9.16; 292.16 ±6.88; 125.51 ±7.26） ng/L, and in control group（40. 58 ±5.34; 287.68 ±8.33; 76.26 ±4.60）ng/L, respectively（ P 〈 0.01 ）. There was no difference between the natives and the control group in bFGF and PDGF（ P 〉 0.05）, while there was predominant difference between the Natives and the control group in VEGF（ P 〈 0.01）. There was a predominant pos- itive correlation between the serum levels of bFGF, PDGF or VEGF and hemoglobin concentrations in CMS respectively （ P 〈 0.01 ）. And there were positive relations between angiogenic growth factors each other. Condusion： The serum levels of bFGF, PDGF and VEGF in patients with CMS significantly increase, these angiogenic growth factors may play important role on the pathophysiologic development of CMS; the increased VEGF level likely contributes to the adaptation to plateau hypoxia in healthy Tibetan natives; the elevated bFGF, PDGF and VEGF levels are likely associated with cxcessive erythropoiesis in CMS.