摘要
目的 探讨血清血管内皮生长因子 (VEGF)与先天性心脏病合并肺动脉高压 (PH)患者肺细小动脉形态改变的关系。方法 2 0 0 2年 1月至 11月共收治 86例左向右分流先天性心脏病患者 ,分为三组 :先天性心脏病不合并PH组 33例 ,肺动脉平均压 (MPAP) <2 0mmHg(1mmHg =0 133kPa) ;先天性心脏病合并PH(PH组 ) 4 7例 ,MPAP >2 0mmHg ;先天性心脏病合并紫绀组 6例 ,MPAP >90mmHg。采用酶联免疫吸附法 (ELISA)测定VEGF动脉血清含量 ,作肺组织活检 ,观察肺血管的病理改变及测定肺小动脉显微形态指标。结果 所有肺活检标本按Heath与EdwardsⅥ级分类进行病理分级 :无PH组肺血管无病理改变 ;PH组Ⅰ级 9例 ,Ⅱ级 14例 ,Ⅲ级 19例 ,Ⅳ级 5例 ;紫绀组 (≥Ⅴ级 ) 6例。随着肺血管病理改变分级的增加 ,血清VEGF在Ⅲ、Ⅳ级时达到高峰值 ,≥Ⅴ级后有明显下降的趋势 ,血流动力学指标和肺细小动脉显微指标测定均呈阶梯样变化 ,MPAP、PVR、mMTPA、WA/TA、EA/TA和TWPV在无PH组与PH组Ⅰ级 ,PH组Ⅰ级与Ⅱ级、Ⅲ级、Ⅳ级及紫绀组 (≥Ⅴ级 )之间具有显著性差异 (P <0 0 1)。血清VEGF在发生紫绀前期与MPAP、PVR、mMTPA、WA/TA和TWPV呈显著正相关 ,而与EA/TA呈显著负相关 (P <0 0 1)。
Objective To assess the relationship of serum vascular endothelial growth factor (VEGF) and the pulmonary vessel micromorphometric indexes in patients with congenital heart disease complicated by pulmonary hypertension(PH). Methods 86 patients with congenital heart disease were divided into three groups, no PH group (33 patients), with preoperative mean pulmonary artery pressure (MPAP)<20mm Hg; PH group: (47 patients), with preoperative MPAP>20 mm Hg, and cyanosis group (6 patients), with preoperative MPAP>90mm Hg. The concentration of serum VEGF were measured with ELISA; and the pulmonary vessel micromophometric indexes were measured according to Heath Edwards pathologic grading. Results In no PH group, there was no any change in pulmonary vessel structure, but in PH group, 9 patients belonged to grade Ⅰ, 14 patients were gradeⅡ, 19 patients were grade Ⅲ, and 5 patients were grade Ⅳ. In cyanosis group, the pathologic grade of 6 patients were all more than grade Ⅴ. With the increasing of pathological grade of pulmonary vessel, the serum VEGF concentration, MPAP, pulmonary vessel resistance (PVR), mean medial thickness in pulmonary arterioles (mMTPA), relative ratios of vessel wall area/total area (WA/TA) and percentage of thick walled peripheral lung vessel (TWPV) increased gradually, while the relative ratios of vessel lumen area/total area (EA/TA) decreased gradually. For all indexes above, there was a significant difference between no PH group and grade Ⅰ, grade Ⅰand grade Ⅱ, gradeⅡ and grade Ⅲ, grade Ⅲ and grade Ⅳ in PH group and cyanosis group ( P <0 01). Before cyanosis appearing, correlation analysis revealed that the serum VEGF concentration was positively correlated with MPAP, PVR, mMTPA, WA/TA, TWPV, but negatively correlated with EA/TA ( P <0 01). Conclusion There was a close relationship among the serum VEGF concentration and shearing force lesion, hyperplasia and cleavage of pulmonary vessel endothelial, and VEGF played an important role in the process of pulmonary vessel remodelling in the patients with congenital heart disease complicated by PH.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2004年第1期40-43,共4页
Chinese Journal of Cardiology
基金
山东省科学技术厅星火计划资助项目 (0 2 2 13 0 161)
