一氧化氮在慢性阻塞性肺疾病中的作用机制及应用价值

The Mechanism of Action and Applied Value of Nitric Oxide in Chronic Obstructive Pulmonary Disease

慢性阻塞性肺疾病(COPD)是一种以不完全可逆性气流受限及气道持续性炎症为特征的疾病,呈进行性发展,临床上以进行性呼出气流减少、呼气末容量增大、低氧血症、高碳酸血症和进行性肺动脉高压为特征。在COPD的病理生理过程中,由于炎性因子或介质、血管内皮、血小板、黏附因子的作用,逐渐产生血栓前状态,导致COPD患者肺部微小动脉血栓形成,肺血管重构,导致肺动脉高压,最终引起右心衰竭。因此,肺动脉高压是COPD发展至肺心病的关键环节,阐明肺动脉高压的形成机制,并寻求理想的降低肺动脉高压的方法,一直是防治COPD、肺心病的重要研究课题。一氧化氮(NO)是近年来发现的生物活性物质之一,其可作为神经递质、信使及调节因子等参与机体许多生理、病理过程。NO具有广泛的功能,如血管调节、神经传导、宿主防御及细胞毒性作用。越来越多的研究表明NO参与肺血管张力调节及肺血管结构重建,在由COPD向肺心病的发展过程中以及在调节肺功能和肺疾病中起着重要作用。因此,本文就一氧化氮在慢性阻塞性肺疾病发展过程中的作用机制及其应用价值进行综述,以期为COPD更好的治疗提供依据。

Chronic obstructive pulmonary disease（COPD） is a progressive disease characterized by irreversible airway obstruction and persistent airway inflammation and which is clinically characterized by progressive expired gas reduction,end-expiratory volume increase,hyoxemia,hypercapnia and progressive pulmonary hypertension.In the COPD pathophysiological events,due to the role of inflammatory factor or medium,vascular endothelium,platelet and adhesion factor,the body gradually produces former thrombosis state,resulting in patients with COPD lung tiny arterial thrombosis,pulmonary vascular remodeling,causing pulmonary arterial hypertension,and resulting in right heart failure at last.Therefore,pulmonary hypertension is the key link to the development of COPD to cor pulmonale.Clarifying the formation mechanism of pulmonary hypertension and seeking the ideal method for reducing pulmonary arterial hypertension are important research subjects for COPD or cor pulmonale prevention.Nitric oxide（NO） is one of biological activity materials,which is found in recent years.It can be used as neurotransmitter,messenger and regulatory factor to participate in many physiological and pathological processes of the body.NO has extensive functions,such as vascular adjustment,nerve conduction,host defense and cytotoxic effect.More and more studies show NO participating in pulmonary vascular tension adjustment and pulmonary vascular structures reconstruction.It plays an important role in the development process of COPD to cor pulmonale and in regulation of lung function and pulmonary diseases.Therefore,mechanism of action and application value of nitric oxide in the development process of chronic obstructive pulmonary disease are reviewed in this article so as to provide a basis for better treatment of COPD.