血浆利钠肽及其活化酶corin在慢性低氧性肺动脉高压患者中的变化及意义探讨

Changes and significances of natriuretic peptide and cardiac protease corin in patients with hypoxic pulmonary hypertension

目的:探讨corin与利钠肽在慢性低氧性肺动脉高压发生发展中的临床意义及其对病情的评估作用。方法:纳入慢性低氧性肺动脉高压患者158例,分为2个亚组:轻度肺动脉高压组118例(Ⅰa组)、中重度肺动脉高压组40例(Ⅰb组);健康对照组60例(Ⅱ组)。ELISA法检测3组患者血浆corin、心房利钠肽(ANP)、脑利钠肽(BNP)、ANP前体(pro-ANP)及BNP前体(pro-BNP)水平,心脏彩色多普勒超声测定肺动脉收缩压(SPAP),血气分析检测动脉血氧分压(PaO_2)。计算pro-ANP/ANP与pro-BNP/BNP比值。采用Spearman检验进行相关性分析。结果:Ⅰa组血浆corin表达水平显著高于Ⅱ组,Ⅰb组较Ⅱ组与Ⅰa组均显著下降(均P<0.01);Ⅰa组与Ⅰb组血浆ANP、pro-ANP、BNP及pro-BNP均明显高于Ⅱ组,且Ⅰb组显著高于Ⅰa组(均P<0.01);Ⅰa组pro-ANP/ANP与pro-BNP/BNP均较Ⅱ组显著降低,Ⅰb组较Ⅰa组显著升高(均P<0.01)。相关性分析显示:在Ⅰa组与Ⅰb组中,SPAP与pro-ANP、ANP、pro-BNP、BNP均存在正相关性;在Ⅰa组中,血浆corin与pro-ANP、ANP、pro-BNP、BNP均存在正相关性;而在Ⅰb组中,corin与pro-ANP、ANP、pro-BNP、BNP均存在负相关性。结论:corin与利钠肽及其前体在不同肺动脉高压阶段中表达异常,且二者表达水平具有相关性,提示corin介导利钠肽活化过程,从而参与慢性低氧性肺动脉高压的发生发展。

Objective:To explore the clinical significance of corin and natriuretic peptide in the occurrence and development of chronic hypoxic pulmonary hypertension(CHPH).Method:A total of 158 patients with CHPH were enrolled and divided into two subgroups:118 patients with mild CHPH were included into GroupⅠa,and 40 patients with moderate to severe CHPH were included into GroupⅠb.Other 60 healthy subjects were enrolled into GroupⅡ.Levels of plasma corin,atrial natriuretic peptide(ANP),brain natriuretic peptide(BNP),ANP precursor(pro-ANP)and BNP precursor(pro-BNP)were measured by ELISA.Pulmonary arterial systolic pressure(SPAP)was measured by color Doppler echocardiography,and arterial partial oxygen pressure(PaO2)was measured by blood gas analysis.The ratio of pro-ANP/ANP and proBNP/BNP were calculated.Correlation analysis was used by Spearman test.Result:The level of plasma corin in groupⅠa was significantly higher than that in groupⅡ,and was significantly lower in in groupⅠb than those in groupⅡand groupⅠa(all P<0.01).Levels of plasma ANP,pro-ANP,BNP and pro-BNP in groupⅠa and groupⅠb were significantly higher than those in groupⅡ,and were significantly higher in groupⅠb than those in groupⅠa(all P<0.01).pro-ANP/ANP and pro-BNP/BNP in groupⅠa were significantly lower than those in groupⅡ,and were significantly higher in groupⅠb than those in groupⅠa(all P<0.01).The correlation analysis showed that SPAP was positively correlated with pro-ANP,ANP,pro-BNP and BNP in groupⅠa and groupⅠb;Plasma corin was positively correlated with pro-ANP,ANP,pro-BNP and BNP in groupⅠa,but negatively correlated with pro-ANP,ANP,pro-BNP and BNP in groupⅠb.Conclusion:Corin and natriuretic peptide are abnormally expressed in different stages of pulmonary hypertension,and their expression levels are correlated,suggesting that corin mediates the activation of natriuretic peptideandparticipates in the occurrence and development of CHPH.