血管活性因子ET-1、cAMP、SDF-1在合并肺动脉高压的风湿性二尖瓣狭窄患者围术期的表达及临床意义的研究
发布时间：2018-01-15 10:34
本文关键词：血管活性因子ET-1、cAMP、SDF-1在合并肺动脉高压的风湿性二尖瓣狭窄患者围术期的表达及临床意义的研究 出处：《川北医学院》2017年硕士论文 论文类型：学位论文
更多相关文章： 肺动脉高压 风湿性心脏病 内皮素-1 环磷酸腺苷 基质细胞衍生因子-1 血管活性因子
【摘要】：目的:肺动脉高压(Pulmonary Arterial Hypertension,PAH)是风湿性二尖瓣狭窄的重要合并症之一,其严重程度通常与不良预后及死亡风险呈正相关,因此提高对风湿性二尖瓣狭窄围术期PAH的认识、诊断及治疗水平显得颇为重要。传统的彩色多普勒超声心动图仅是根据三尖瓣反流速峰值及右房压粗略评估肺动脉压,右心导管肺动脉测压虽准确性高,但为有创性检查。血管活性因子内皮素-1(Endothelin 1,ET-1)、环磷酸腺苷(Cyclic Adenosine Monophosphate,c AMP)和基质细胞衍生因子-1(Stromal Cell Derived Factor 1,SDF-1)在充血性肺动脉高压患者围术期的表达研究较多,但在风湿性二尖瓣狭窄患者的研究甚少。本文研究了以上三种血管活性因子在合并PAH的风湿性二尖瓣狭窄患者围术期的表达情况及其与术前PAH的相关性,以期为风湿性二尖瓣狭窄的诊断、治疗及预后判断提供理论依据。方法:本研究选取风湿性二尖瓣狭窄合并PAH患者29例(拟行二尖瓣置换术),年龄41~69岁,平均53±9.29岁,术前心功能II~III级(NYHA),排除合并特发性肺动脉高压、充血性肺动脉高压、慢性血栓栓塞性肺动脉高压、肺疾病所致肺动脉高压、肺静脉不全梗阻与堵塞、缺血性心肌病、肝肾功能不全、严重感染性疾病患者。按术前彩色多普勒超声心动图所测肺动脉收缩压(Systolic Pulmonary Artery Pressure,SPAP)分成三组,A组(轻度肺动脉高压组)9例,SPAP:36~50mm Hg;B组(中度肺动脉高压组)13例,SPAP:50~70mm Hg;C组(重度肺动脉高压组)7例,SPAP≥70 mm Hg。患者均在静吸复合麻醉、血液中度稀释及中低温状态下接受手术。患者均在麻醉诱导前(T1)、CPB停止即刻(T2)及术后12h(T3)、术后24h(T4)、术后48h(T5)、术后72h(T6)、术后120h(T7)、术后168h(T8)这八个时间点从肘静脉抽取4ml血液,血标本置于抗凝管中,并将标本离心(3000 r/min,离心半径13.5cm,离心10 min),后分离血浆至EP管中于-70℃冰箱中冻存待测,待全部收集完后同批采用酶联免疫试剂盒测定ET-1、c AMP及SDF-1浓度。结果:合并PAH的风湿性二尖瓣狭窄患者,麻醉诱导前(T1)各组SPAP和外周血浆ET-1、c AMP、SDF-1水平组间比较具有显著性差异(P㩳0.05),具体表现为:重度肺动脉高压组㧐中度肺动脉高压组㧐轻度肺动脉高压组。外周血浆ET-1、c AMP及SDF-1水平随着SPAP的升高而升高,且c AMP和SDF-1与SPAP的相关性更密切。合并PAH的风湿性二尖瓣狭窄患者,围术期外周血浆ET-1浓度呈先升高后逐渐降低趋势,C组升高速度最快、幅度最大,B组次之,A组最慢、最小。A组下降时间最早,下降速度也最快,出现在术后12h;B组于术后24h开始下降;C组于术后48h开始下降,且下降速度最慢。血浆c AMP浓度呈逐渐降低趋势,C组下降速度最慢,A组和B组下降速度稍快,A组168h内平均下降了15.67 nmol/L、B组下降了15.21 nmol/L、C组下降了14.05 nmol/L。血浆SDF-1浓度呈缓慢降低趋势,A、B组下降速度稍快于C组,但术后168h内总体下降程度不大。结论:1.合并PAH的风湿性二尖瓣狭窄患者,术前外周血浆ET-1、c AMP、SDF-1水平随着SPAP的增大而升高,二者呈正相关。2.合并PAH的风湿性二尖瓣狭窄患者,外周血浆ET-1水平在术后短时间内呈上升趋势,之后逐渐下降,且下降速度与SPAP呈负相关。3.合并PAH的风湿性二尖瓣狭窄患者,外周血浆c AMP、SDF-1水平术后呈逐渐下降趋势,下降速度与SPAP呈负相关。
[Abstract]:Objective: pulmonary arterial hypertension (Pulmonary Arterial, Hypertension, PAH) is one of the most important complication of rheumatic mitral stenosis and its severity with poor prognosis and death risk was positively correlated, therefore to improve the understanding of rheumatic mitral stenosis and perioperative PAH, diagnosis and treatment is very important. The traditional color Doppler ultrasound echocardiography is only three according to tricuspid peak velocity and right atrial pressure against a rough assessment of pulmonary arterial pressure, pulmonary arterial pressure, right heart catheterization and high accuracy, but is invasive. Endothelin -1 (Endothelin 1, ET-1), cyclic adenosine monophosphate (Cyclic Adenosine Monophosphate, C AMP) and stromal cells -1 (Stromal Cell Derived derived factor Factor 1, SDF-1) on the expression of perioperative patients with congestive pulmonary hypertension, but studies in rheumatic mitral stenosis patients in this study very little. The above three kinds of correlation between expression of vasoactive factors in the perioperative period in patients with rheumatic mitral stenosis complicated with PAH and PAH before the operation, in order to rheumatic mitral stenosis diagnosis, treatment and prognosis to provide a theoretical basis. Methods: This study selected 29 cases of PAH patients with rheumatic mitral stenosis (scheduled mitral valve replacement), aged 41~69 years old, average 53 + 9.29 years, preoperative heart function II~III (NYHA), excluding the patients with idiopathic pulmonary arterial hypertension, congestive pulmonary hypertension, chronic thromboembolic pulmonary hypertension, pulmonary artery disease caused by hypertension, pulmonary venous obstruction and blockage of ischemic cardiomyopathy, liver and kidney dysfunction, patients with serious infectious disease. According to preoperative color Doppler echocardiography measured pulmonary artery systolic pressure (Systolic Pulmonary Artery Pressure, SPAP) were divided into three groups, group A (mild pulmonary hypertension group) 9 渚，
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