肺血管内皮细胞激活在先天性心脏病肺高压肺血管重构中的作用

目的探讨肺血管内皮细胞激活在左向右分流型先天性心脏病(先心病)肺动脉高压(肺高压)发生、发展及肺血管重构中的作用。方法将先心病室间隔缺损(室缺)合并轻、中、重度肺高压患者30例作为研究对象;10例单纯室缺患者作为对照组。所有患者于体外循环建立前抽取肘正中静脉血,同时取右肺中叶小块肺组织,放射免疫法或比色法测定血浆白介素-1(IL-1)、内皮素(ET-1)和一氧化氮(NO)含量,以反映肺血管内皮细胞激活、损伤程度;QTM970图像分析仪测定肺组织肺小动脉外径、管壁厚度、血管总面积;计算出管壁厚度占外径的百分比(WT/D),管壁面积占血管总面积的百分比(WA/A),以反映肺小血管的形态学改变。结果先心病患者伴随肺动脉压力的增高,血浆IL-1β和ET-1/NO水平呈上升趋势(P<0.05);WT/D、WA/A逐渐增高(P<0.05);二者呈显著正相关(P<0.05)。结论左向右分流所致肺血管内皮细胞激活与内皮衍生因子分泌失衡密切相关;其在肺高压发生及肺血管重构中起重要作用。

The role of endothelicyte activation in the development of pulmonary hypertension with congenital heart disease and vascular remodeling

Objective To discuss the role of endothelicyte activation in the development of pulmonary hypertension (PH) and vascular remodeling. Methods A total of 10 patients with simple ventricular septal defect(VSD)of congenital heart disease(CHD)were choosen as controls, and 30 patients with different degree of PH were studied. Plasma levels of interleukin-1(IL-1), endothelin-1 (ET-1) and nitric oxide (NO) which represented the degree of endothelicyte activation were measured by radioimmunoassay and commercial available kit. The specimens taken from right lung before cardiopulmonary bypass were fixed by formaldehyde solution. The percentage of vascular wall thickness/vascular external diameter (WT/D) and the percentage of vascular area/total vascular area (WA/A) which represented vascular remodeling, were measured by QTM970 analysator. Results Compared with patients of simple VSD, the plasma levels of IL-1, ET-1/NO and WA/A, WT/D increased in patients with PH. Conclusion The activation of endothelicytes and imbalance of ET/NO play an important role in the development of PH and vascular remodeling. Positive correlations were seen between IL-1, ET-1/NO and WA/A, WT/D(P<(0.05)).