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1.
目的 了解心力衰竭患者血浆内皮索-1(ET-1)、血管紧张素Ⅱ(AngⅡ)和降钙素基因相关肽(CGRP)的变化,并观察福辛普利对其的影响.方法 测定40名健康者(正常对照组)和90例心力衰竭患者血浆ET-1、AngⅡ和CGRP浓度,随后90例心力衰竭患者被随机分成常规治疗组和福辛普利组(常规治疗+福辛普利10 mg,1次/d),每组45例.治疗14 d后复测血浆ET-1、AngⅡ和CGRP浓度,同时应用彩色多普勒超声显像仪测量正常对照组和心力衰竭患者治疗前后的左心室射血分数(LVEF).结果 与正常对照组相比较,心力衰竭患者血浆ET-1、Ang Ⅱ明显升高(P<0.01),ET-1和AngⅡ与LVEF呈负相关(r=-0.71,r=0.62,P<0.01),ET-1和AngⅡ呈正相关(r=0.69,P<0.01).治疗14 d后,福辛普利组血浆ET-1和AngⅡ明显下降(P<0.01),CGRP显著升高,(P<0.01),LVEF得到改善(P<0.05),而常规治疗组无明显变化(P>0.05).结论 心力衰竭患者血浆ET-1、AngⅡ浓度明显升高,且与LVEF呈负相关,血浆CGRP显著下降.福辛普利具有降低ET-1和Ang I、升高CGRP并改善LVEF的作用.  相似文献   

2.
目的 探讨X综合征病人血浆内皮素-1(ET-1)和降钙素基因相关肽(CGRP)浓度变化与发病的关系.方法 测定34例X综合征病人ET-1和CGRP的血浆浓度,同时与29例无心肌缺血的对照组作比较分析.结果 ET-1:X综合征组血浆浓度(81.94±10.76ng/L)显著高于对照组(56.71±11.29ng/L,P<0.01).CGRP:X综合征组血浆浓度(50.74±13.26)ng/L显著低于对照组(64.89±11.58ng/L,P<0.01).ET-1/CGRP比值:X综合征组(1.58±0.49)显著高于对照组(0.91±0.33,P<0.01).结论 显著增高的ET-1水平和明显降低的CGRP浓度在X综合征发病中起重要作用.  相似文献   

3.
目的 :探讨影响先天性心脏病 ( CHD)患儿血浆内皮素 - 1( ET- 1)水平的因素及临床意义。方法 :选择69例左向右分流的 CHD患儿 ,其中伴肺动脉高压 ( PH) 5 0例 ,轻度 PH17例 ,中度 PH16例 ,重度 PH17例 ;不伴PH 19例。分别采股静脉血 ,伴有中、重度 PH 3 3例患儿随机给予前列腺素 E1 ( PGE1 ,16例 ) 2 0 ng/ ( kg· min)静脉滴注或卡托普利 ( 17例 ) 1mg/ ( kg· d)口服治疗 15 d后再采血 ,用放射免疫法测定样品中 ET- 1含量。结果 :1肺血流量增加 ,血浆 ET- 1水平亦增加 ,达正常对照 2倍多 ( P <0 .0 0 1) ;2 CHD并 PH者血浆 ET- 1水平较无PH者明显增高 ( P<0 .0 0 1) ,ET- 1含量随肺动脉压力的升高而增加 ;3 PGE1 可显著降低 PH患儿的平均肺动脉压 ( P <0 .0 5 )及血浆 ET- 1水平 ( P <0 .0 5 ) ;4卡托普利可使患儿的平均肺动脉压及血浆 ET- 1水平下降 ,但与治疗前比较差异无显著性意义 ( P >0 .0 5 )。结论 :PGE1 和卡托普利可能延缓 PH的发展。  相似文献   

4.
目的探讨肺心病患者血浆CGRP,ET-1水平与PA I-1基因4G/5G多态性的相关性。方法用放免法测定正常组与肺心病组血浆CGRP,ET-1水平;PCR技术检测肺心病PA I-1基因4G/5G多态性的基因型,并分析不同式因型血浆CGRP,ET-1的水平。结果肺心病组和正常对照组血浆ET-1含量分别为77.4±13.1ng l/L和52.2±15.6ng/L,差异有显著性(P<0.01)。肺心病组和正常对照组CGRP血浆含量分别为23.6±14.4ng/L和48.3±17.5ng/L,两者间具有显著性差异(P<0.01)。4G/4G基因型肺心病患者血浆ET-1水平明显高于4G/5G和5G/5G基因型肺心病患者(P<0.05)。结论肺心病患者血冰岛CGRP水平与ET-1水平呈负相关,共同参与肺心病病理过程的调节;4G/4G多态性能影响ET-1的活性,二者在肺心病发生发展中具有协同作用。而CGRP与4G/5G多态性无相关性。  相似文献   

5.
目的 探讨心包积液患者心包液中降钙素基因相关肽(CGRP)、内皮素(ET-1)与积液量、心功能的关系。方法 35例心包积液患者按NYHA标准分为心功能Ⅲ、Ⅳ级,行超声心动图检查,计算积液量。行经皮穿刺心包腔内留置导管引流术时,取心包液及静脉血。正常对照组(血浆)30例。用放射免疫分析法测定心包液和血浆中CGRP、ET-1的浓度。 结果 心包液CGRP、ET-1的浓度显著高于血浆中的浓度(P<0.01),血浆中CGRP、ET-1含量较正常对照组明显升高(P<0.01),且心包液和血浆中CGRP、ET-1水平均与心功能相关(分别为P<0.01和P<0.05),心包液中CGRP、ET-1浓度与积液量呈正相关(分别为r=0.43、r=0.38,P<0.05)。结论 心包积液患者心包液中CGRP、ET-1的浓度与心功能、积液量密切相关。  相似文献   

6.
目的探讨内源性硫化氢(H2S)与高原地区慢性肺心病肺动脉高压的相关性。方法高原地区慢性肺心病稳定期患者72例和健康对照组40例,分别测定血浆H2S、内皮素-1(ET-1)、平均肺动脉压(mPAP)、动脉血氧分压(PaO2)和二氧化碳分压(PaCO2)。结果肺心病稳定期患者血浆H2S、PaO2水平显著低于健康对照组(均P<0.01),而血浆ET-1、mPAP和PaCO2水平显著高于健康对照组(均P<0.01)。肺心病组患者血浆H2S水平与ET-1、mPAP、PaCO2呈显著负相关(分别为r=-0.718、-0.692、-0.556,均P<0.01),与PaO2呈显著正相关(r=0.583,P<0.01)。结论内源性H2S可能参与了高原肺心病患者肺动脉高压的发生发展,血浆H2S作为一种无创指标监测PAH的严重程度和预后具有一定意义。  相似文献   

7.
目的 通过观察葶苈生脉方对充血性心力衰竭(CHF)大鼠血浆内皮素-1(ET-1)、降钙素基因相关肽(CGRP)含量的影响,探讨其治疗CHF的作用机制.方法 采用腹主动脉缩窄法复制CHF大鼠模型,随机分为假手术组、模型组、葶苈生脉方高、低剂量组、阳性药心宝丸对照组.测定大鼠血浆ET-1、CGRP的含量.结果 与假手术组比较,模型组大鼠血浆ET-1含量明显升高,血浆CGRP含量显著降低(P<0.01).与模型组比较,各治疗组均能降低ET-1含量,升高CGRP含量(P<0.01).结论 葶苈生脉方通过调节大鼠ET-1和CGRP的分泌和释放以抗CHF.  相似文献   

8.
目的 :探讨血浆内皮素 (ET)及内皮衍生舒张因子 (EDRF)与先天性心脏病 (先心病 )肺动脉高压的关系。方法 :取 30例分流型先心病患者 (先心病组 ) ,其中肺动脉高压者 16例 ,肺动脉压力正常者 14例 ,用右心导管法测其肺循环血流动力学参数。并在心腔内不同部位取血 ,用以检测其ET及EDRF的浓度。并与 30例健康者对照 (对照组 )。结果 :先心病肺动脉高压者肺循环ET产生增加 ,且与肺动脉压力呈正相关 ;而其EDRT产生减少 ,且与肺动脉压力呈负相关 ;肺动脉压力正常者与对照者无差异。结论 :肺动脉高压时ET产生增加 ,而E DRF产生减少 ,可能参与了肺动脉高压形成的病理生理过程  相似文献   

9.
目的探讨室间隔缺损(VSD)封堵术对患者血浆脑钠尿肽(BNP)、心房钠尿肽(ANP)的影响及意义。方法以在我院接受封堵术治疗的187例VSD患者为研究对象,按心脏超声测得的肺体循环血流量比值(Qp/Qs)分为A组(Qp/Qs<1.5,98例)与B组(Qp/Qs≥1.5,89例);分别于封堵术当日07∶00及封堵术后24 h、72 h各抽取静脉血5 m l,用酶联免疫吸附法检测血BNP浓度,用放射免疫法检测血清ANP浓度。结果①B组肺动脉压力较A组显著升高(P<0.05)。②术前B组血浆BNP浓度较A组及对照组显著升高(P<0.05);术后24 h及72 h两组血浆BNP浓度均较术前显著升高(P<0.01),而术后72 h虽较术后24 h有下降趋势,但无统计学差异。③术前两组患者血浆ANP浓度均较对照组显著升高(P<0.05),而术后72 h则较术前显著降低(P<0.05),其中A组已达正常对照组水平。结论VSD患者血浆BNP及ANP浓度与肺循环血量多少及肺动脉压力呈正相关;术后早期血浆ANP浓度的变化特征,可作为VSD封堵术后远期疗效判断的一项重要指标。  相似文献   

10.
目的 探讨血浆内皮素-1(ET -1)与降钙素基因相关肽(CGRP)在不同病情肺源性心脏病(肺心病)患者中的变化及其意义.方法 采用酶联免疫吸附试验(ELISA)检测52例肺心病急性加重期患者及48例缓解期患者血浆中的ET-1及CGRP水平,并与30名健康体检者的上述指标比较.结果 与健康对照组比较,肺心病急性加重期组及缓解期组血浆ET-1水平显著升高,CGRP显著降低,差异有统计学意义(P<0.001),肺心病急性加重期组ET-1水平较缓解期组升高(P<0.05),两组间CGRP水平差异无统计学意义(P>0.05).肺心病急性加重期ET -1与CGRP呈负相关(r=-0.277,P<0.05).结论 肺心病患者存在血浆中ET-1及CGRP水平失衡,血浆ET-1与CGRP升高可能是该病病情加重的原因之一.  相似文献   

11.
探讨超声测量肺循环阻力和体循环阻力比值(PVR/SVR)的方法。超声测量43例先天性心脏病患儿左、右室射血前期(LPEP,RPEP)、射血期(LET,RET)和加速期(LAT,RAT),同时测量主、肺动脉血流量(Qs,Qp)。进而计算RPEP:Qp、RPEP:ET:Qp、RPEP:AT:Qp、RPEP:Qp/LPEP:Qs、RPEP:ET:Qp/LPEP:ET:Qs和RPEP:AT:Qp/LPEP:AT:Qs。结果:超声测量RPEP:Qp、RPEP:ET:Qp和RPEP:AT:Qp与心导管测量的PVR/m2比较,r分别为0.66、0.65和0.75。超声测量RPEP:Qp/LPEP:Qs、RPEP:ET:Qp/LPEP:ET:Qs和PREP:AT:Qp/LPEP:AT:Qs与心导管测量PVR/SVR比较,r分别为0.78、0.78和0.89。其中RPEP:AT:Qp/LPEP:AT:Qs与PVR/SVR相关最好。超声测量RPEP:AT:Qp/LPEP:AT:Qs能较准确地估测PVR/SVR。  相似文献   

12.
BACKGROUND: The vasoconstrictor action of endothelin-1 (ET-1) is mediated through ET(A) and ET(B) receptor subtypes on vascular smooth muscle. ET(B) receptors are also present on the vascular endothelium where they mediate vasodilation. Animal studies suggest that the ET(B) receptor also acts as a clearance receptor for endothelin. AIMS: To investigate the effects of a selective ET(A) and a selective ET(B) receptor antagonist alone and in combination on haemodynamics and circulating concentrations of ET-1 in patients with chronic heart failure. RESULTS: Infusion of BQ-123 (n=10), a selective ET(A) receptor antagonist, led to systemic vasodilation and did not change plasma ET-1 concentrations (1.38+/-0.82 to 1.38+/-0.91 fmol/ml, ns). Infusion of BQ-788 (n=8) led to systemic vasoconstriction with a rise in plasma ET-1 (1.84+/-1.06 to 2.73+/-0.99 fmol/ml, p<0.01). The addition of BQ-123 to BQ-788 led to systemic and pulmonary vasodilation with no further increase in plasma ET-1 concentrations (2.80+/-1.14 to 2.90+/-1.20 fmol/ml, ns). CONCLUSION: The rise in plasma ET-1 concentrations in response to selective blockade of ET(B) receptors and the associated adverse haemodynamic effects suggest that ET(B) receptors have a role in the clearance of ET-1 in man and that their blockade may not be advantageous for patients with heart failure.  相似文献   

13.
目的探讨吸入依洛前列环素(iloprost)对先天性心脏病(CHD)继发肺动脉高压(PAH)患者的肺动脉压力(PAP)、肺血管阻力(PVR)、心指数(CI)的影响。方法给予34例CHD继发PAH患者吸入iloprost和生理盐水,分别测量吸入iloprost和生理盐水后肺动脉收缩压(SPAP)、肺动脉舒张压(DPAP)、肺动脉平均压(MPAP)、PVR,CI、体循环平均压(MAP)和心率(HR),比较两组指标的差异。结果吸入iloprost后PAH患者的SPAP、DPAP、MPAP和PVR下降,CI增加,MAP、HR无明显变化。结论吸入iloprost可安全有效地降低PAH患者的PAP和PVR,增加CI。  相似文献   

14.
目的 分析先天性心脏病(CHD)并发肺动脉高压(PAH)(CHD-PAH)患者手术后不良事件、右房大小改善的危险因素。方法 收治79例CHD-PAH患者。初诊,右心导管检查和吸氧实验,确诊PAH、肺血管反应性,其中13例患者肺血管阻力(PVR)<10 Wood单位、体循环血流量(Qp)与肺循环血流量(Qs)的比值(Qp/Qs)≥1.5、血氧饱和度(SaO2)≥95%,且心功能较好者直接行手术治疗,其余66例患者接受靶向药物治疗3个月后,复查右心导管进行评估手术。结果 术后不良事件发生17例,其中肺高压危象11例,撤机困难需气管切开4例以及低心排综合征2例。53例患者术后右房恢复正常大小。有无不良事件组间比较结果显示:术前PVR≥10 Wood单位、Qp/Qs、SaO2、肺动脉收缩压/主动脉收缩压(SPAP/SBP)>0.75、SPAP、肺动脉舒张压(DPAP)是术后不良事件的影响因素(均P<0.01),多因素Logistic回归分析结果显示SaO2(OR=0.584,P=0.015)越高,不良事件发生率越低;术后右房大小改善是否满意组间单因素分析显示:PVR≥10 Wood单位、右房压(RAP)>8 mmHg(1 mmHg=0.133 kPa)、血流分流方向是其影响因素(均P<0.05),多因素Logistic回归分析结果显示其危险因素是RAP>8 mmHg(OR=3.398,P=0.029)。结论 CHD-PAH患者术后不良事件的危险因素是SaO2的降低,影响右房改善的危险因素是RAP>8 mmHg。  相似文献   

15.
肺心病患者血浆内皮素一氧化氮降钙素基因相关肽的研究   总被引:22,自引:0,他引:22  
目的 研究缺氧性肺动脉高压产生的机理。方法 经右心导管监测55例慢性阻塞性肺疾病(COPD)及慢性肺心病患55例,依平均肺动脉压(mPAP)≥2.67kPa,分为A组(28例)〈2.67kPa分为B组(27例)及22名健康(对照组)观察血流动力学变化,并测定其俩动脉血浆内皮素(ET-1),一氧化氮(NO)和降钙素基因相关肽(CGRP)水平,以探讨了ET-1,NO,CGRP与肺动脉高压的关系。结  相似文献   

16.

Background

No studies have described and evaluated the association between hemodynamics, physical limitations and quality of life in patients with pulmonary hypertension (PH) without concomitant cardiovascular or respiratory disease.

Objective

To describe the hemodynamic profile, quality of life and physical capacity of patients with PH from groups I and IV and to study the association between these outcomes.

Methods

Cross-sectional study of patients with PH from clinical groups I and IV and functional classes II and III undergoing the following assessments: hemodynamics, exercise tolerance and quality of life.

Results

This study assessed 20 patients with a mean age of 46.8 ± 14.3 years. They had pulmonary capillary wedge pressure of 10.5 ± 3.7 mm Hg, 6-minute walk distance test (6MWDT) of 463 ± 78 m, oxygen consumption at peak exercise of 12.9 ± 4.3 mLO2.kg-1.min-1 and scores of quality of life domains < 60%. There were associations between cardiac index (CI) and ventilatory equivalent for CO2 (r=-0.59, p <0.01), IC and ventilatory equivalent for oxygen (r=-0.49, p<0.05), right atrial pressure (RAP) and ''general health perception'' domain (r=-0.61, p<0.01), RAP and 6MWTD (r=-0.49, p<0.05), pulmonary vascular resistance (PVR) and ''physical functioning'' domain (r=-0.56, p<0.01), PVR and 6MWTD (r=-0.49, p<0.05) and PVR index and physical capacity (r=-0.51, p<0.01).

Conclusion

Patients with PH from groups I and IV and functional classes II and III exhibit a reduction in physical capacity and in the physical and mental components of quality of life. The hemodynamic variables CI, diastolic pulmonary arterial pressure, RAP, PVR and PVR index are associated with exercise tolerance and quality of life domains.  相似文献   

17.
BACKGROUND: Severe pulmonary hypertension (PH) and increased pulmonary vascular resistance (PVR) are important risk factors that predict early postoperative mortality after orthotopic heart transplantation. The aim of our study was to determine the value of B-type natriuretic peptide (BNP) and big endothelin-1 (big ET1) for prediction of severe PH in heart transplant candidates. METHODS: The study population included 43 potential heart transplant candidates (38 males, mean age 52 +/- 7 years). All underwent repeated right-heart catheterizations (2-5 studies) at an interval of 3-4 months, giving a total of 124 examinations, associated with blood sampling for BNP and big ET1 analysis. Severe PH was defined as the mean pulmonary artery pressure (MPAP) > 40 mmHg. RESULTS: Significantly high PVR (PVR > 3.0 Wood units and TPG > 15 mmHg) was noted on 12 occasions in 10 patients; always in the presence of severe PH. Low BNP levels (<67 pg/ml) ruled out the presence of severe PH with a 100% sensitivity, however, with a low specificity (34%). An increase in plasma BNP > 30 pg/ml (>40% of initial value) in subjects with a previous MPAP< or =40 mmHg detected development of severe PH with a 100% sensitivity and an 80-88% specificity. As a total of 58% of patients presented repeatedly with MPAP< or =40 mmHg, serial BNP testing could reduce the need for hemodynamic studies in this subgroup down to 12-20%. CONCLUSIONS: Serial BNP testing in hemodynamically stable heart transplant candidates with MPAP< or =40 mmHg allows reliable detection of development of severe PH, and may significantly reduce the need for repeated right-heart catheterizations in these patients.  相似文献   

18.
目的探讨内皮素(ET-1)、C-MYC癌基因在先天性心脏病(CHD)合并肺动脉高压(PH)形成过程中的生物作用。方法42例左向右分流CHD患者,根据肺动脉平均压(MPAP)的高低分为三组,正常组:MPAP<20mmHg,11例;肺动脉高压组:MPAP>20mmHg,22例;重度肺动脉高压组:MPAP>70mmHg,9例。采用放免法测定血浆ET-1浓度。所有病例均行肺活检术,标本常规制成蜡块,应用免疫组化方法,单克隆抗C-MYC基因蛋白抗体作一抗,观察肺组织中C-MYC癌基因的定位及表达。结果C-MYC癌基因主要分布于肺动脉内皮细胞、平滑肌和成纤维细胞等细胞的胞核中。血浆ET-1浓度和C-MYC癌基因表达各组之间差异有统计学意义(P<0.05),各病理分级之间差异有统计学意义(P<0.05),随着肺小动脉病理分级的加重而升高,并且二者的表达与病理分级有明显的相关性(P<0.05)。结论ET-1和C-MYC癌基因在CHD合并PH的形成过程中起着重要的生物学作用,ET-1可以刺激C-MYC癌基因的表达,进而促进平滑肌细胞和成纤维细胞增殖。  相似文献   

19.
Pulmonary hypertension in systemic lupus erythematosus   总被引:15,自引:0,他引:15  
A prospective echocardiographic and clinical study was performed on 84 Chinese patients with systemic lupus erythematosus (SLE) and 99 controls to investigate the prevalence and the mechanism of pulmonary hypertension (PH) in SLE. Comparison between Doppler estimation and catheterization measurement was made in 12 cases to validate the predictive method. Compared to normal subjects, lupus patients had significantly increased sys-tolic pulmonary artery pressure (SPAP) (29.59±12.52 vs 19.64±5.82, P<0.001), mean pulmonary artery pressure (MPAP) (15.11±7.36 vs 10.21±4.72, P<0.001) and total pulmonary resistance (TPR) (315.85±190.65 vs 220.37± 55.92, P<0.001). Nine of the 84 patients presented PH, defined as SPAP >30 mmHg and MPAP >20 mmHg. Pulmonary hypertensive patients had higher serum endothelin (ET) than non-pulmonary hypertensive patients, were more commonly in active stages, and presented Raynaud's phenomenon and rheumatoid factors. ET level was correlated with echocardiographic pulmonary pressure. Pulmonary hypertension commonly occurs in Chinese patients with SLE (11%), and it correlates with the lupus activity and the elevation of serum endothelin. Received: 29 April 1998 / Accepted: 30 September 1998  相似文献   

20.
BACKGROUND: Bronchiectasis may have deleterious effects on cardiac function secondary to pulmonary hypertension (PH). This study was designed to assess cardiac function and determine the prevalence of PH in patients with cystic and cylindrical bronchiectasis. METHODS: A cross-sectional study of patients with bronchiectasis diagnosed by CT scan was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia between December 2005 and January 2007. Pulmonary function tests were performed, arterial blood gas measurements were made, and cardiac function and systolic pulmonary artery pressure (SPAP) were assessed by echocardiography. RESULTS: Of 94 patients (31% men, n = 29), 62 patients (66%) had cystic bronchiectasis and 32 patients (34%) had cylindrical bronchiectasis. Right ventricular (RV) systolic dysfunction was observed in 12 patients (12.8%), left ventricular (LV) systolic dysfunction was observed in 3 patients (3.3%), and LV diastolic dysfunction was observed in 11 patients (11.7%); all had cystic bronchiectasis. RV dimensions were significantly greater in the cystic bronchiectasis group, and were positively correlated with SPAP (p < 0.0001) and negatively correlated with Pao2 (p < 0.016). Other hemodynamic variables were not different between groups. PH in 31 patients (32.9%) was significantly greater in patients with cystic bronchiectasis compared with cylindrical bronchiectasis (p = 0.04). In cystic bronchiectasis, SPAP was positively correlated with Paco2 (p = 0.001), and inversely correlated with Pao2 (p = 0.03), diffusion capacity of the lung for carbon monoxide percentage (p = 0.02), and FEV1 (p = 0.02). CONCLUSIONS: RV systolic dysfunction and PH were more common than LV systolic dysfunction in bronchiectatic patients. LV diastolic dysfunction was mainly seen in severe PH. We recommend detailed assessment of cardiac function, particularly LV diastolic function, in patients with bronchiectasis.  相似文献   

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