肺心病血管内皮细胞功能改变及双硝基异山梨醇干预的影响

The vescular endothilial dysfunction on patients with cor pulmonale and the effect of intervention using intravenous Isasobide Dinitrate(ISDN)

目的 观察静脉滴注双硝基异山梨醇 (ISDN)对肺心病血管内皮功能的影响。方法 5 0例肺心病病人 ,干预组 4 0例 ,对照组 10例 ,干预组静脉滴注双硝基异山梨醇6h ,对照组滴注生理盐水 ,静脉滴注前后检测血浆一氧化氮(NO)、6 酮前列腺素F1α(6 KPGF1α)、内皮素 1(ET 1)、血栓素B2 (TXB2 )水平及血流动力学变化。另有 10例健康者检测血浆NO、6 KPGF1α、ET 1、TXB2 水平。所有 5 0例肺心病病人干预前及 10例健康者进行循环内皮细胞 (CEC)的检测。结果5 0例肺心病患者TXB2 、ET 1、mPAP、TPR、CEC均高于健康人而NO、6 KPGF1α 显著低于健康者。干预后血浆NO、6 KPGF1α,较干预前明显升高P <0 0 1、ET 1、TXB2 明显降低(P <0 0 1)。肺动脉平均压、全肺阻力均有降低 (P <0 0 1)对照组无变化。循环内皮细胞计数为 (12 6± 1 9)个 / 0 .9mL ,高于健康组P <0 0 1。结论 肺心病患者存在血管内功能障碍 ,而ISDN对肺心病的作用。

Objectives To investigate the vescular endothelial dysfunction on patients with cor pulmonale and to observe the effect of intervention using intravenous ISDN. Methods The plasma levels of NO、6 KPGF 1α \, ET 1\, TXB 2 and CEC data were measured in 50 patients with cor pulmonale and 10 healthy persons. Hemodynamic studies were performed in these 50 patients. 40 of them were treated with intravenous ISDN lasting for 6 hr. The orther 10 patients were treated with intravenous normal saline as a control. When the treatment was completed, the plasma level of NO、6 KPGF 1α \, ET 1\, TXB 2 were measured again. Results In patients with cor pulmonale, the plasma level of TXB 2\, ET 1 and mPAP\, TPR\, ECE data are more higher and the level of NO\, 6 KPGF 1α are more lower than healthy group. After the intravenous ISDN treatment completed, the plasma level of TXB 2, ET 1 and mPAP\, TPR and much decreased, and the level of NO\, 6 KPGF 1α remarkably increased. Conclusions Vascular endothelial dysfunction may be a characteristic feature of some patients with cor pulmonale. Intravenous ISDN may be an effective therapy on pulmonary hypertension and vescular endothelial dysfunction.