经皮腔内球囊二尖瓣成形术前后肿瘤坏死因子和一氧化氮血浆水平变化的研究

The study on plasma levels of tumor necrosis factor and nitric oxide before and after pecutaneous transluminal balloon mitral valvuloplasty

目的 :研究经皮腔内球囊二尖瓣成形术 (PTBMV)前后肿瘤坏死因子 (TNF-α)和一氧化氮 (NO)血浆水平变化。方法 :2 0例二尖瓣狭窄 (MS)患者 (MS组 )分别于 PTBMV前、后采静脉血和左房血各 5 ml,术后 5 d再采静脉血 5 ml。同期还采 12例正常者 (对照组 )静脉血 5 m l。以酶联免疫吸附法检测血浆 TNF-α浓度 ,重氮反应比色法检测血浆 NO浓度。MS组 PTBMV前、后均检测二尖瓣口面积 (MVA)、左房平均压 (ML AP)、舒张期跨二尖瓣压差 (DMTV G)及心排血指数 (CI)。将血浆 TNF- α和 NO浓度与血流动力学参数作相关分析。结果 :MS组术前静脉血 TNF- α和 NO浓度均明显高于对照组 (P <0 .0 1)。术后 30 m in静脉血浆和左房血浆 TNF- α和N O浓度均较术前显著升高 (P <0 .0 1)。术后第 5天静脉血浆 TNF- α和 NO浓度较术前及术后 30 m in均显著下降 (P <0 .0 1) ,但仍显著高于对照组 (P <0 .0 1)。MS组不同时点及部位血浆 TNF- α与 NO浓度均值之间呈显著性正相关 (r =0 .97,P <0 .0 1)。术前及术后第 5天静脉血浆 TNF- α和 NO浓度分别与 DMTVG呈正相关 (r=0 .92 ,P <0 .0 1和 r =0 .93,P <0 .0 1) ,与 CI呈负相关 (r =- 0 .86 ,P <0 .0 1和 r =- 0 .89,P <0 .0 1)。结论 :TNF- α和 NO可能参与 MS的病理生理过程 ,?

Objective:This study was to investigate the changes of plasma levels of tumor necrosis factor alpha (TNF α) and nitric oxide (NO) before and after percutaneous transluminal balloon mitral valvuloplasty (PTBMV) in the patients with mitral stenos (MS) and to explore their implication. Method:This study included 20 patients with MS. Blood samples were obtained from vein and left atrium before PBMV and after the procedure and from vein on the 5th day following the operation. Vein blood samples were taken from 12 normal subjects. Plasma concentrations of TNF α and NO were measured by ELISA and colorimetry, respectively.Mitral valve area(MVA), mean left atrial pressure (MLAP), diastolic mean transmitral valve gradient (DMTVG) and cardiac index (CI) were measured before and after PTBMV. The correlations were made between plasma levels of TNF α and NO and the changes of hemodynamic parameters. Result:In the patients with MS, the vein plasma levels of TNF α and NO were singnicantly higher than those in normal controls (P< 0.01 ) before PTBMV. There were no singnificant difference between the plasma levels of TNF α and NO in vein and in the left atrium in patients with MS before PTBMV (P> 0.05 ).The plasma levels of TNF α and NO in vein and left atrium at 30 min after PTBMV were increased remarkably (P< 0.01 ) than those before PTBMV (P< 0.01 ) in patients with MS. On the 5th day after PTBMV, the vein plasma levels of TNF α and NO were significantly decreased (P< 0.01 ) as compared with those before and at 30 min after PTBMV in patients with MS, but they were singnificantly higher than those in the normal controls (P< 0.01 ). There was significant positive correlation between mean plasma levels of TNF α and NO at a variety of time points or locations with MS(r= 0.97 , P< 0.01 ). There were significant positive or negative correlation between the plasma levels of TNF α before and on 5th day after PTBMV and the changes of DMTVG (r= 0.92 , P< 0.01 ) or CI(r=- 0.86 , P< 0.01 ) in patients with MS,where were the same as between NO and DMTVG (r= 0.93 , P< 0.01 ) or CI(r=- 0.89 , P< 0.01 ). Conclusion:This study suggests that TNF α and NO may play an important roles in the pathophysiological process of MS. The plasma levels of TNF α and NO may be valuable markers for evaluating the severity of MS and the effect of PTBMV.