扩张型心肌病血浆内皮素水平变化的研究

A study on changes of the plasma endothelin level in patients with dilated cardiomyopathy

目的 探讨扩张型心肌病 (DCM)血浆内皮素(Endothelin ,ET)水平变化的意义 ,其与心衰严重程度、心脏大小、左心室泵功能、伴或不伴肺动脉高压的关系 ,及治疗前后ET水平的变化。方法 采用放射免疫法测定 30例DCM患者 (心功能Ⅰ～Ⅳ级 )及 30例正常人血浆ET水平 ,并测定DCM患者的左心室射血分数 (LVEF)、肺动脉压力、心胸比率及治疗前后的ET水平 ,分析血浆ET水平与心衰严重程度、心脏大小、左心室泵功能、肺动脉高压的关系 ,比较其治疗前后的变化。结果 ①DCM患者血浆ET水平 (135 93pg/mL±70 6 5pg/mL)明显高于正常对照组 (43 6 5pg/mL±12 0 7pg/mL) ,P <0 0 5 ;②血浆ET水平随心衰严重程度而升高 :心功能Ⅰ级 (3例 )为 75 2 7pg/mL± 2 87pg/mL ,Ⅱ级(10例 )为 88 82pg/mL± 8 87pg/mL ,Ⅲ级 (12例 )为 136 5 8pg/mL± 2 4 95pg/mL ,Ⅳ级 (5例 )为 2 6 9 5 0pg/mL± 6 0 5 0pg/mL ,各级心功能与正常对照组比较 ,均有显著性差异 (P <0 0 5 ) ,各级心功能之间 ,除Ⅰ级与Ⅱ级比较无显著性差异外(P >0 0 5 ) ,其余各级间两两比较均有显著性差异 (P <0 0 5～ 0 0 1) ;③DCM患者心脏大小与血浆ET水平存在一定的相关关系 (r=0 4 5 80 ,P =0 0 10 9) :心脏正常至轻度增大 (心胸比率 0 4

Objectives To evaluate the changes of the plasma endothelin level in patients with dilated cardiomyopathy, and to investigate the relationship between the plasma endothelin level and the severity of heart failure, heart size, left ventricular function and with or without pulmonary arterial hypertension; the changes of the plasma endothelin level before and after treatment. Methods Determines plasma endothelin level of 30 patients with DCM, 30 healthy control subjects, and LVEF, PAP, heart size, plasma endothelin level before and after treatment. Results Plasma endothelin level in DCM group was significantly higher than that in control group (135 93±70 65) pg/mL vs (43 65±12 07) pg/mL, P<0 05 ; there was a positive correlation between ET level and heart size ( r=0 458 0,P=0 010 9 ); there was a significant negative correlation between LVEF of DCM and ET level ( r=-0 692 2,P=0 002 1 ); and it was a significant positive correlation between ET level and pulmonary arterial hypertension ( r=0 897 4, P<0 000 5 ) After treatment, the ET level decreased significantly than before in DCM group (129 15 pg/mL±43 93 pg/mL) vs (63 12 pg/mL±22 20 pg/mL) , P<0 05 Conclusions Plasma ET level may be a new parameter of evaluating severity of heart failure, efficacy of therapy and prognosis in patients with DCM.