先天性心脏病肺动脉高压患者肺组织内皮型一氧化氮合成酶的表达及肺血管重建

目的　探讨内皮型一氧化氮合成酶 (eNOS)在肺动脉高压的发生、发展及肺血管重建中的作用。方法　经心动超声及多普勒检查 ,确定为单纯室间隔缺损患者 10例为对照组 ;室间隔缺损合并肺动脉高压患者共 3 0例 ,为实验组。体外循环建立前取右肺中叶少许肺组织 ,福尔马林固定 ,石蜡包埋 ,SP法免疫组织化学染色 ,并进行灰度扫描。以管壁厚度占血管外径的百分比 (WT % )、管壁面积占血管总面积的百分比 (WA % )反映肺血管壁的增厚程度。方差分析进行组间差异比较。结果　先心病患者随肺动脉压力的增高 ,肺组织eNOS表达呈下降趋势 ,而肺小血管形态发生明显改变 ,WT %、WA %明显增高 (P <0 .0 1)。eNOS的表达与肺高压程度、肺血管形态学改变之间存在负相关性 (P <0 .0 1)。结论　先心病肺高压的eNOS含量低下 ,造成内源性一氧化氮(NO)生成减少 ,在肺动脉高压的发生、发展及肺血管重建中起一定作用

Expression of eNOS and vascular remodeling in human pulmonary vascular of pulmonary hypertension with congenital heart disease

Objective To discuss the significance of eNOS and NO in the development of pulmonary hypertension(PH) and the vascular remodeling. Methods Ten patients with simple VSD were choosen as controls, and 30 patients with pulmonary hypertension of VSD were studied. The patients with PH were diagnosed by Doppler and Ultrasound, some of them were detached by cardiac catheter. The specimens were taken from middle lobe of the right lung before cardiopulmonary bypass and were fixed by formaldehyde solution, paraffin embedding and stained by SP immunohistochemical technique and usual analysis. The percentage of vascular wall thickness/vascular external diameter (WT%) and the percentage of vascular area/ total vascular area (WA%) were measured. The comparison of the difference in each groups by ONE-WAY ANOVA test. Results The immunostaining for eNOS in the pulmonary vascular endothelium was significantly decreased, and WA% and WT% were increased in patients of different grades of PH (P<0.01), as compared with patients with VSD (P<0.01). Significantly inverse correlations were seen between the immunohistochemical grade and WA%, WT% in patients with PH (P<0.01). Conclusion The expression of eNOS in pulmonary endothelium plays an important role in the development of PH, and correlates with the vascular remodeling.