充血性心力衰竭患者血浆一氧化氮和内皮素等的改变

The effects of nitric oxide and endothelia levels on plasma in patients with chronic heart failure

目的探讨充血性心力衰竭时血浆一氧化氮（ＮＯ）、内皮素（ＥＴ）的变化及前列腺素的影响。方法测定３５例充血性心力衰竭（心衰）患者血浆ＮＯＥＴ血管紧张素转换酶（ＡＣＥ）活性。２０例健康者作对照组。１５例患者静脉滴注前列腺素Ｅ１（ＰＧＥ１，２０～４０ｎｇ·ｋｇ－１·ｍｉｎ－１），Ｓｗａｎｇａｎｚ导管监测血流动力学，用药前后测肺动脉、头静脉血浆ＮＯ、ＥＴ和ＡＣＥ活性。结果心衰患者存在肺动脉高压，心衰组血浆ＮＯ高于对照组，肺动脉血浆中高于自身静脉。心衰组血浆ＥＴ和ＡＣＥ活性呈相似改变。心衰组血浆ＥＴ的增幅大于ＮＯ，ＮＯ／ＥＴ比值下降。上述改变均与心衰严重程度有关（Ｐ＜０．０５）。前列腺素Ｅ１显著降低肺动脉压力，增加心脏指数，降低血浆ＮＯ、ＥＴ和ＡＣＥ水平，增加ＮＯ／ＥＴ比值。结论血浆ＮＯ水平增高是心力衰竭病理生理特征之一。ＮＯ、ＥＴ与ＮＯ／ＥＴ等改变与肺动脉高压和局部血管内皮细胞损伤有关，参与心衰的病理生理。前列腺素Ｅ１可以抑制上述改变。

Objective To study the effects of postaglandin E1 on plasma nitric oxide (NO) and endothelin (ET) levels in patients with chronic heart failure. Methods Pulmonary artery pressare (PAP), pulmonary arterial and venous plasma ET and angiotensin converting enzyme (ACE) levels were determined in patients with chronic heart failure (CHF) and the effects of prostaglandin E1 (PGE1) were evaluated. Results (1) Pulmonary hypertension was present in patients with CHF. Plasma NO and ET levels in the pulmonary artery were higher than those in the pulmony vein (P<0.05),the levels in the latter was in turn higher than those in normal subjects (P<005). (2) Plasma ACE levels showed a similar change, (3) The increase of plasma ET was more than the increase of NO in patients with CHF, thus, NO/ET ratio was decreased in CHF (P<0.05). (4) PGE1 caused significant decrease in PAP but increase in cardial index. It decreased plasma NO, ET, ACE, and increased NO/ET ratio (P<0.05). These effects became more apparent with the increase of PGE1 level. Conclusion NO and NO/ET ratio might be involved in CHF by causing pulmonary hypertension and local vascular endthalium perturbation. PGE1 could inhibit these effects and play an important role in the prevention and treatment of CHF.