医药学论文：肺源性心脏病患者血浆C型利钠肽、肾上腺髓质素的变化及意义

【摘要】 目的 探讨C型利钠肽(CNP)及肾上腺髓质素(ADM)在慢性肺源性心脏病中的作用和意义。方法 以住院的慢性肺源性心脏病患者作为实验组，以同期健康体检者作为对照组，用放射免疫法检测血浆中CNP、ADM的水平，比较CNP、ADM在实验组100例患者(慢性肺源性心脏病急性加重期和临床缓解期)和对照组60例健康体检者中水平的变化,同时测定血氧分压和二氧化碳分压。结果 (1)慢性肺源性心脏病急性加重期和临床缓解期的CNP、ADM含量均显著高于正常对照组(P＜0.01)；(2)慢性肺源性心脏病急性加重期CNP、ADM的含量显著高于临床缓解期(P＜0.01)；(3)慢性肺源性心脏病患者中CNP、ADM 与血氧分压呈负相关(r= -0.622,-0.702,P＜0.05)，与血二氧化碳分压相关性不明显(r=0.205,0.233,P＞0.05) ；(4)血浆CNP与ADM呈正相关 (r=0.279, P＜0.05)。结论 CNP、ADM参与了慢性肺源性心脏病的病理生理过程；通过观察血浆CNP、ADM水平变化,可以反映慢性肺源性心脏病的病情。

 

　　【关键词】 C型利钠肽；肾上腺髓质素；肺源性心脏病
Changes of plasma c-type natriuretic peptide and plasma adrenomedullin in patients with chronic pulmonary heart disease

 

 

 

【Abstract】 Objective To explore the role and clinical significance of plasma c-type natriuretic peptide (CNP) and adrenomedullin (ADM) levels in patients with chronic pulmonary heart disease.Methods Patients with chronic pulmonary heart disease in hospital, including acute exacerbation stage or clinical alleviated stage totally 100 cases, were participated in the study as experiment group. Meanwhile, 60 cases healthy persons were served as control group. Plasma CNP and ADM were measured by radioimmoassay and compared in the two groups, oxygen partial pressure and carbon dioxide partial pressure were measured at the same time.Results (1) the levels of plasma CNP and ADM in urgent aggravation stage of experiment group and clinical alleviation stage all were higher than the control group (P＜0.01）；(2) the levels of plasma CNP and ADM in experiment group were higher than in control group significantly(r= -0.622, -0.702,P＜0.05)；(3) the levels of plasma CNP and ADM in patients with chronic pulmonary heart were negatively correlated with oxygen partial pressure but no relationship with carbon dioxide partial pressure(r=0.205,0.233,P＞0.05)；(4) The levels of plasma CNP was positively correlated with ADM(r=0.279, P＜0.05).Conclusion The plasma CNP and ADM were participated in the pathosphysiology process of pulmonary heart disease and reflected patient's condition.

 

 

　　【Key words】 C-type natriuretic peptide; adrenomedullin; pulmonary heart disease(cor pulmonal)

 

　　肺动脉高压的形成是慢性肺源性心脏病的主要发病机制之一, 而肺血管阻力增加及肺动脉血管的结构重塑又是产生肺动脉高压的主要原因。笔者在慢性肺源性心脏病急性加重期和临床缓解期中检测了血浆C型利钠肽(c-type natriuretic peptide,CNP)、肾上腺髓质素(ADM)水平,探讨二者在肺动脉高压形成过程中的作用。

 

　　1 对象与方法

 

　　1.1 对象 慢性肺源性心脏病患者100例, 均为我院的住院患者, 男56例,女44例, 年龄45～82岁, 诊断根据2002年中华医学会呼吸病学分会拟订的《慢性阻塞性肺疾病诊治指南》和1979年全国慢性肺源性心脏病专业会议修订的《慢性肺源性心脏病诊断标准》。对照组60例，为同期健康体检者，男33例，女27例，年龄48～78岁。

 

　　1.2 方法 慢性肺源性心脏病急性加重期入院后第1天作为治疗前，经治疗缓解出院前1天作为治疗后，标本注明急性加重期和临床缓解期。所有受检者均于入院后第1天抽取空腹肘静脉血2ml，置含10%EDTA二钠30μl和抑肽酶40μl的试管中混匀检测CNP与ADM。应用中国科技大学实业总公司生产的 GC-911- r放免计数器进行测定，CNP 放免试剂盒为解放军总院放免研究所产品，ADM放免试剂盒为美国凤凰公司产品，严格按说明书操作,给出有关参数。100例患者经治疗至临床缓解期于出院前1天再次抽血检测上述指标。同时行动脉血气分析。