慢支、肺气肿并肺动脉高压的特征及其机制探讨  

A STUDY OF CHARACTERISTICS OF PULMONARY HYPERTENSION WITH CHRONIC BRONCHITIS AND EMPHYSEMA IN RATS

作　　者：张建全[1] 钟小宁[1] 蒋明[1] 柳广南[1] 

机构地区：[1]广西医科大学第一附属医院呼吸内科,南宁530021

出　　处：《广西医科大学学报》2006年第3期375-378,共4页Journal of Guangxi Medical University

基　　金：广西自然科学基金资助项目(No.桂科自0229024)

摘　　要：目的:探讨慢性阻塞性肺疾病(COPD)肺动脉高压的不同阶段的特征及其相关机制。方法:将40只Wistar大鼠随机分成5组,每组8只。A组:低氧性肺动脉高压组,10%低氧,8h/d,2周;B组:慢支、肺气肿并肺动脉高压组,分别于第1天、第14天经气管注入脂多糖(LPS)200μg,烟熏2h/d,6周,最后2周同时叠加18%低氧,8h/d;C组:慢支、肺气肿组,分别于第1天、第14天经气管注入LPS200μg,烟熏2h/d,共6周;D组:18%低氧,8h/d,2周;E组:正常对照组,正常饲养6周。各组作血气分析,肺血流动力学测定和肺泡灌洗液(BALF)白细胞总数及分类计数。观测气道及肺组织和肺血管的病理组织学改变。结果:①与E组比较A、B组PaO2呈不同程度降低(P<0·05),A、B组右心室收缩压(RVSP)、平均肺动脉压(mPAP)、右心室与左心室+室间隔重量比(RV/LV+S)升高(P<0·05)。A、B组肌化型动脉(MA)增多,管壁增厚(P<0·05);②C、D组血气分析无变化(P>0·05),与E组比较,C组RVSP、mPAP、RV/LV+S升高(P<0·05),C组MA增多(P<0·05),但管壁无增厚(P>0·05);D组肺血流动力学、肺血管重塑指标无改变(P>0·05);③支气管肺泡灌洗液(BLAF)中,A、D组白细胞总数及分类计数与E组相当(P>0·05),病理主要以上皮细胞变性坏死、黏液杯状细胞增生为主,炎细胞浸润不明显(P>0·05)。B、C组白细胞总数及分类计数增多(P<0·05),中性粒细胞比例增多(P<0·05),气道病理符合慢支、肺气肿改变,管壁呈现以淋巴细胞为主的多种炎细胞浸润。结论:COPD肺动脉高压在无低氧时期已经形成,炎症因素起重要作用,早期肺血管重塑以MA比例增高为主要表现,低氧加剧了病情的发展,并出现MA肌层的增厚,管腔变小。Objective：To evaluate the characteristics of pulmonary hypertension with COPD in different stages. Methods：40 Wistar rats were divided into 5 groups： Group A （ n =8） Rats were treated with chronic hypoxia（FiO2 =0.18）for two weeks with 8 h/d. Group B （ n =8） Rats were treated with intratracheal instillation of lipopolysaccharide （LPS） on d land d 14, and daily exposed to cigarette smog for 6 weeks and chronic hypoxia （FiO2 =0.18） 8 h/d simultaneously In the next 2 weeks. Group C （ n =8） were daily exposed to cigarette smog for 6 weeks and had intratracheal instillation of LPS on d1 and d14 . Group D （ n = 8） rats were exposed to chronic hypoxia（FiO2 =0.18） 8 h/d for 2 weeks. Group E （ n =8） rats were bred for 6 weeks in normal circumstance. The blood gas analysis, pulmonary hemodynamic changes and the morphological changes of airways and pulmonary vascular structure were observed. Total cell counts and their differentiation in bronchoalveocar lavage fluids （BALF） were done. Result：①compared with group E, PaO2 was decreased in Group A and Group B（ P d0.05）, but not in other groups（ P〉0.05） ;②Right ventricular systolic pressure （RVSP） , mean pulmonary arterial pressure （mPAP） and the ratio of the weight of right ventricle/left ventricle and septum （RV/LV＋S） were higher in Group A and B than that in Group E（ P 〈0.05）. Muscularization of intra-alceolar arteries in Group A and B were significantly apparent cornpared with Group E（ P〈0.05） . The cross-sectional medial vascular wall area of pulmonary arteries were increased significantly in Group A compared with Group E （ P〈0.05 ）, were not in Group B （ P〉0.05）. Pulmonary hemodynamic changes and pulmonary vascular structure were not observed in Group D; ③The number of white cell and neutrophils in BALF of Group A and D were the same as Group E（ P〈0.05）, Epithelial cell necrosis was the main pathological change. Neutrophil percentages were increased in Group B and Gr

关 键 词：COPD 肺动脉高压 烟熏 脂多糖 低氧 

分 类 号：R562.11[医药卫生—呼吸系统] R563.3[医药卫生—内科学]