前列腺素E_1对血管内皮生长因子含量的影响及其与肺小动脉病理分级的关系

The effects of prostaglandin E_1 on serum vascular endothelial growth factor and its relation to different pathologic gradings of pulmonary arteriole

目的 研究应用前列腺素 E1 ( PGE1 )对先天性心脏病合并肺动脉高压 ( PH)患者血清血管内皮生长因子( VEGF)含量的影响及其与肺小动脉病理分级的关系。 方法 2 0 0 2年 1月至 2 0 0 3年 6月共收治先心病合并 PH患者 5 3例 ( MPAP>2 0 m m Hg) ,其中有明显紫绀 6例 ( MPAP>90 m m Hg)。入院后静脉滴注 PGE1 10～ 15 ng/ kg· min,每天用药 12小时 ,连续 15天。分别于用药 0、5、10和 15天晨抽取静脉血 ,采用酶联免疫吸附法 ( EL ISA)测定血清VEGF含量。做肺组织活检 ,按 Heath和 Edwards分类进行病理分级 ,观察肺小动脉的病理改变。 结果 病理分级 : 级 9例 , 级 14例 , 级 19例 , 级 5例 ,≥ 级 (紫绀者 ) 6例。应用 PGE1 前 ,肺小动脉病理分级 级时血清VEGF达到峰值 , 级、特别是≥ 级后有明显下降的趋势 ;应用 PGE1 后 , 级血清 VEGF与用药前比较差别无显著性意义 ( P>0 .0 5 ) , 、 级者血清 VEGF明显降低 ( P<0 .0 1) , 级者有轻度的降低 ( P<0 .0 5 ) ,而≥ 级患者无明显变化 ( P>0 .0 5 )。 结论 PGE1 可降低血清 VEGF含量 ,其降低幅度与肺小动脉病理改变程度有较密切的关系 。

Objective To investigate the effect of prostaglandin E1 (PGE1) on serum vascular endothelial growth factor(VEGF) in patient with pulmonary hypertension secondary to congenital heart disease and its relation to different pathologic gradings of pulmonary arterioles. Methods Fifty three patients suffering from pulmonary hypertension secondary to congenital heart disease were chosen at random to undergo active tissue test of lung, including 6 patients suffering from severe cyanosis. All of them were intravenously dripped with PGE 1 for 15 days at the speed of 10 15 ng /kg·min, 12 hours a day. Venous blood was taken for study in the morning on the day before infusion, on the 5th day, the 10th day, and the 15th day after infusion. Then the concentration of VEGF was measured by enzyme linked immunosorbent assay (ELISA). Lung biopsy was taken from each patient and pathologic grading performed according to Heath and Edwards pathologic grading. Results Fifty three patients were classified into Grade Ⅴ:9 of them belonged to Grade Ⅰ, 14 to Grade Ⅱ, 19 to Grade Ⅲ, 5 to Grade Ⅳ, the other 6 with severe cyanosis belonged to Grade Ⅴ or even severe than Grade Ⅴ. Before administration of PGE 1, serum VEGF reached the peak while the pathologic grading of pulmonary arteriole was Grade Ⅲ, VEGF level markedly decreased in Grade Ⅳ and Ⅴ. After administration of PGE 1 serum VEGF in Grade Ⅰ showed no difference with that before administration of PGE 1( P >0.05), VEGF decreased in GradeⅡ and Ⅲ ( P <0.01), slightly decreased in Grade Ⅳ ( P < 0.05), while patients greater or equivalent to Grade Ⅴ showed no VEGF change during the course of PGE 1 administration ( P >0.05). Conclusions PGE 1 can lower the VEGF level, but the extent closely relates to the degree of pathologic change in pulmonary arteriole. It might be a pre operative parameter for pathologic grading of pulmonary arteriole.