动脉硬化闭塞症手术前后血浆内皮素-1、一氧化氮测定的临床意义

Clinical significance of endothelin-1 and nitric oxide determination in the patients with arteriosclerosis obliterans before and operation

目的 探讨周围动脉硬化闭塞症 (ASO )人工血管转流手术后血浆内皮素 1(ET 1)、一氧化氮 (NO)水平的变化规律及其临床意义。方法 选择 3 2例行人工血管转流手术的ASO患者 ,利用放射免疫和Grisse方法测定其术前、术后 1、3、7、14d以及术后 1、6、12个月血浆ET 1、NO水平 ,同时对 16例人工血管移植术后再狭窄者以及 3 2例健康查体者进行血浆ET 1、NO水平的测定。结果 3 2例ASO患者以及 16例再狭窄患者均存在高ET 1和低NO血症。 2 8例手术效果良好者 ,血浆ET 1水平于术后 1d明显升高 ,术后 3d开始下降 ,于术后 14d恢复正常水平 ,而NO则呈相反变化曲线 ,亦于术后 14d恢复正常 ;4例术后血运得到改善者 ,术后 3个月后缺血症状加重 ,并逐渐发现吻合口高度狭窄或闭塞 ,其血浆ET 1和NO水平术后 2周内得到改善 ,但后期再次出现高ET 1血症和低NO血症。结论 ASO患者及术后再狭窄患者存在高ET 1血症和低NO血症 ,围手术期动态观察血浆ET 1和NO水平 ,有助于评价治疗效果、判断预后和预测吻合口再狭窄的发生。

Objective To investigate the alterations of endothelin-1 and nitric oxide and their clinical significance in the patients with atherosclerosis obliterans (ASO) after operations.Methods The levels of edothelin-1 and nitric oxide were determined by radioimmunoassy and Grisse methods in 32 cases of atherosclerosis obliterans,16 cases of anastomotic restenosis (AR) after artificial blood vessel transplantation and 32 normal controls.The dynamic alterations of endothelin-1 and nitric oxide levels were observed before operation and on the first day,third day,7th day,14th day,first month,6th month and 12th month after operation,and were compared with clinical data.Results The higher levels of endothelin-1 and lower levels of nitric oxide were demonstrated in 32 cases of ASO and 16 cases of AR as compared with the controls.The abnormal levels returned to normal on the 14th day after operation in 28 cases,while these abnormal levels appeared again when the AR occurred in 4 cases.Conclusion The ASO patients and AR patients have higher levels of endothelin-1 and lower levels of nitric oxide.The dynamic observations on endothelin-1 and nitric oxide are helpful to evaluate the therapeutic effect,to judge the progress and to predict the occurrence of AP during operation.