本文關(guān)鍵詞：血管活性因子ET-1、cAMP、SDF-1在合并肺動(dòng)脈高壓的風(fēng)濕性二尖瓣狹窄患者圍術(shù)期的表達(dá)及臨床意義的研究　出處：《川北醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肺動(dòng)脈高壓 風(fēng)濕性心臟病 內(nèi)皮素-1 環(huán)磷酸腺苷 基質(zhì)細(xì)胞衍生因子-1 血管活性因子

【摘要】：目的:肺動(dòng)脈高壓(Pulmonary Arterial Hypertension,PAH)是風(fēng)濕性二尖瓣狹窄的重要合并癥之一,其嚴(yán)重程度通常與不良預(yù)后及死亡風(fēng)險(xiǎn)呈正相關(guān),因此提高對(duì)風(fēng)濕性二尖瓣狹窄圍術(shù)期PAH的認(rèn)識(shí)、診斷及治療水平顯得頗為重要。傳統(tǒng)的彩色多普勒超聲心動(dòng)圖僅是根據(jù)三尖瓣反流速峰值及右房壓粗略評(píng)估肺動(dòng)脈壓,右心導(dǎo)管肺動(dòng)脈測壓雖準(zhǔn)確性高,但為有創(chuàng)性檢查。血管活性因子內(nèi)皮素-1(Endothelin 1,ET-1)、環(huán)磷酸腺苷(Cyclic Adenosine Monophosphate,c AMP)和基質(zhì)細(xì)胞衍生因子-1(Stromal Cell Derived Factor 1,SDF-1)在充血性肺動(dòng)脈高壓患者圍術(shù)期的表達(dá)研究較多,但在風(fēng)濕性二尖瓣狹窄患者的研究甚少。本文研究了以上三種血管活性因子在合并PAH的風(fēng)濕性二尖瓣狹窄患者圍術(shù)期的表達(dá)情況及其與術(shù)前PAH的相關(guān)性,以期為風(fēng)濕性二尖瓣狹窄的診斷、治療及預(yù)后判斷提供理論依據(jù)。方法:本研究選取風(fēng)濕性二尖瓣狹窄合并PAH患者29例(擬行二尖瓣置換術(shù)),年齡41~69歲,平均53±9.29歲,術(shù)前心功能II~III級(jí)(NYHA),排除合并特發(fā)性肺動(dòng)脈高壓、充血性肺動(dòng)脈高壓、慢性血栓栓塞性肺動(dòng)脈高壓、肺疾病所致肺動(dòng)脈高壓、肺靜脈不全梗阻與堵塞、缺血性心肌病、肝腎功能不全、嚴(yán)重感染性疾病患者。按術(shù)前彩色多普勒超聲心動(dòng)圖所測肺動(dòng)脈收縮壓(Systolic Pulmonary Artery Pressure,SPAP)分成三組,A組(輕度肺動(dòng)脈高壓組)9例,SPAP:36~50mm Hg;B組(中度肺動(dòng)脈高壓組)13例,SPAP:50~70mm Hg;C組(重度肺動(dòng)脈高壓組)7例,SPAP≥70 mm Hg�；颊呔陟o吸復(fù)合麻醉、血液中度稀釋及中低溫狀態(tài)下接受手術(shù)。患者均在麻醉誘導(dǎo)前(T1)、CPB停止即刻(T2)及術(shù)后12h(T3)、術(shù)后24h(T4)、術(shù)后48h(T5)、術(shù)后72h(T6)、術(shù)后120h(T7)、術(shù)后168h(T8)這八個(gè)時(shí)間點(diǎn)從肘靜脈抽取4ml血液,血標(biāo)本置于抗凝管中,并將標(biāo)本離心(3000 r/min,離心半徑13.5cm,離心10 min),后分離血漿至EP管中于-70℃冰箱中凍存待測,待全部收集完后同批采用酶聯(lián)免疫試劑盒測定ET-1、c AMP及SDF-1濃度。結(jié)果:合并PAH的風(fēng)濕性二尖瓣狹窄患者,麻醉誘導(dǎo)前(T1)各組SPAP和外周血漿ET-1、c AMP、SDF-1水平組間比較具有顯著性差異(P㩳0.05),具體表現(xiàn)為:重度肺動(dòng)脈高壓組㧐中度肺動(dòng)脈高壓組㧐輕度肺動(dòng)脈高壓組。外周血漿ET-1、c AMP及SDF-1水平隨著SPAP的升高而升高,且c AMP和SDF-1與SPAP的相關(guān)性更密切。合并PAH的風(fēng)濕性二尖瓣狹窄患者,圍術(shù)期外周血漿ET-1濃度呈先升高后逐漸降低趨勢,C組升高速度最快、幅度最大,B組次之,A組最慢、最小。A組下降時(shí)間最早,下降速度也最快,出現(xiàn)在術(shù)后12h;B組于術(shù)后24h開始下降;C組于術(shù)后48h開始下降,且下降速度最慢。血漿c AMP濃度呈逐漸降低趨勢,C組下降速度最慢,A組和B組下降速度稍快,A組168h內(nèi)平均下降了15.67 nmol/L、B組下降了15.21 nmol/L、C組下降了14.05 nmol/L。血漿SDF-1濃度呈緩慢降低趨勢,A、B組下降速度稍快于C組,但術(shù)后168h內(nèi)總體下降程度不大。結(jié)論:1.合并PAH的風(fēng)濕性二尖瓣狹窄患者,術(shù)前外周血漿ET-1、c AMP、SDF-1水平隨著SPAP的增大而升高,二者呈正相關(guān)。2.合并PAH的風(fēng)濕性二尖瓣狹窄患者,外周血漿ET-1水平在術(shù)后短時(shí)間內(nèi)呈上升趨勢,之后逐漸下降,且下降速度與SPAP呈負(fù)相關(guān)。3.合并PAH的風(fēng)濕性二尖瓣狹窄患者,外周血漿c AMP、SDF-1水平術(shù)后呈逐漸下降趨勢,下降速度與SPAP呈負(fù)相關(guān)。
[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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