摘要
为探讨内皮素（ＥＴ）的分泌机制，我们研究了３５例患者二尖瓣球囊扩张术前后血浆ＥＴ浓度与心力衰竭程度、心房颤动和血液动力学参数的关系。结果显示３５例患者肘静脉基础血浆ＥＴ浓度显著高于３２例正常对照组（１５．４０±３．３２比９．５９±２．６６ｐｇ／ｍｌ，Ｐ＜０．００１）；其中１５例心功能Ⅲ级的患者明显高于２０例心功能Ⅱ级的患者（１７．６７±１．９９比１３．７０±３．１１ｐｇ／ｍｌ，Ｐ＜０．００１），并显著高于对照组（分别Ｐ＜０．００１）；１３例心房颤动患者明显高于２２例窦性心律患者（１６．８５±２．９１比１４．５５±３．３１ｐｇ／ｍｌ，Ｐ＜０．０５）。术后１０～１５ｍｉｎ时，股静脉血浆ＥＴ浓度从术前的１６．１４±３．３４降到１３．７４±３．７８ｐｇ／ｍｌ（Ｐ＜０．０１）。术后７２ｈ时，肘静脉的血浆ＥＴ浓度已降至１２．３１±２．５５ｐｇ／Ｍ（与术前及对照组比，Ｐ＜０．００１），但心房颤动患者血浆ＥＴ浓度与窦性心律患者比较已无显著差异（１３．３１±１．５５比１１．７３±２．８６ｐｇ／ｍｌ，Ｐ＞０．０５）。术前股静脉血浆ＥＴ浓度与平均左房压（ｒ＝０．５２１，Ｐ＜０．００２）和平均右房压（ｒ＝０．４５０，Ｐ＜０．０１）?
To investigate the secretory mechanism of endothelin,the relationships between plasma concentrations of immunoreactive endothelin and the grades of heart failure,atrial fibrillation and hemodynamic parameters before and after percutaneous balloon mitral valvuloplasty (PBMV) in 35 patients with mitral stenosis were studied. The basal plasma concentrations of endothelin in blood from antecubital vein of the patients were significantly higher than that in 32 control subjects (15.40±3.32 vs.9.59±2.66 pg/ml, respectively,p<0.001).Plasma endothelin concentrations in patients of NYHA classes Ⅱ(13.70±3.11 pg/ml, n=20)and Ⅲ(17.67±1. 99 pg/ml, n=15, P<0.001 vs. class Ⅱ)were significantly higher than that in control subjects (both p<0.001).Concentration of plasma endothelin in patients with atrial fibrillation (AF, n=13) was significantly higher than that in patients with normal sinus rhythm (SR ,n=22) (16.85±2.91 vs.14.55±3.31 pg/ml, respectively,p<0.05).10 to 15 minutes after PBMV,plasma endothelin concentration in blood from the femoral vein significantly decreased from 16.14±3.34 to 13.74±3.78 pg/ml (p<0.01).72 hours after the procedure,the concentrations in blood from the antecubital vein fell to 12.31±2.55 pg/ml(p<0.001 vs. before PBMV and control subjects),but there was no significant difference between AF and SR patients (13.31±1.55 vs. 11. 73±2. 86 pg/ml,respectively, p>0.05).Plasma endothelin concentrations in blood from the femoral vein correlated with the mean left atrial pressure (r=0.521,p<0.002)and the mean right atrial pressure (r=0.450, p<0.01) before the first balloon inflation.Concentration of plasma endothelin in blood from the antecubital vein correlated positively with the heart rate (r=0.460,p<0.01), but did not correlate significantly with the mean transmitral pressure gradient (r=0.292,p>0.05)and mitral valve area (r=-0.145,p>0.50)before PBMV. The results revealed that plasma endothelin concentration is closely related to the cardiac function and several hemodynamic parameters, and the increase of plasma endothelin concentration in patients with atrial fibrillation might be directly due to arrhythmia por se or indirectly due to the hemodynamic changes.
出处
《中国循环杂志》
CSCD
1995年第11期651-654,共4页
Chinese Circulation Journal
关键词
二尖瓣狭窄
球囊扩张术
围手术期
内皮素
Mitral stenosis
Percutaneous balloon mitral valvuloplasty
Endothelin
