出 处:《国际呼吸杂志》2013年第11期819-824,共6页International Journal of Respiration
基 金:南通市社会事业科技创新与示范计划项目(HS2011038)
摘 要:目的分析慢性阻塞性肺疾病(COPD)继发的肺动脉高压(PAH)与炎症反应的相关性,研究阿托伐他汀对COPD合并PAH患者的治疗作用及可能机制。方法收集我科稳定期单纯性COPD患者(40例),COPD合并PAH患者(45例)血清及呼出气冷凝液(EBC)标本,并常规行肺功能、动脉血气分析、超声心动图、6分钟步行距离(6MWD)、肝。肾功能检测。乳胶增强透射免疫比浊法测定血清及EBC中高敏G反应蛋白(hs—CRP)。ELISA方法检测血清及EBC中肿瘤坏死因子-α(TNF—α)。将稳定期cOPD合并PAH患者随机分成治疗组(23例)和对照组(22例),对照组给予常规治疗,治疗组加用阿托伐他汀20mg/d口服,6个月后观察两组的肺动脉压力、动脉血气分析、肺功能、6MWD、肝肾功能、血清及EBC中hs—CRP、TNF-α水平。结果与单纯性COPD组相比,COPD合并PAH组PaO2、6MWD明显降低(P值均〈0.05),血清及EBC中hs—CRP、TNFa水平明显增高(P值均〈0.05),且Pa0。、6MWD与肺动脉收缩压(PASP)呈负相关(r=-0.472,P〈0.05;r=-0.435,P〈0.05),血清及EBC中hs—CRP、TNF—α均与PASP呈正相关(r=0.350~0.598,P值均〈0.05),6个月后,治疗组PASP力比同组治疗前和对照组治疗后均有明显降低(P〈0.05),差异有统计学意义;治疗组PaO2、6MWD比同组治疗前及对照组治疗后均有明显增高(P〈0.05),差异有统计学意义;两组血清及EBC中hs—CRP、TNF-α均明显降低(P值均〈0.05),但治疗组较对照组降低更明显,差异有统计学意义。结论全身及肺脏局部炎症反应可能参与了COPD继发的PAH形成过程。阿托伐他汀可降低COPD合并PAH患者肺动脉压力,改善动脉血氧分压及运动耐量,其机制可能与抑制全身及肺脏局部炎症反应有关。Objective The purpose of the present study was to investigate potential role of inflammation in pulmonary arterial hypertension (PAH)of chronic obstructive pulmonary disease (COPD), observe the effects of atorvastatin treatment in patients with COPD combining with PAH and explore the effect mechanism. Methods The forty patients with single COPD and forty-five stable COPD complicating PH participated in this study. Exhaled breath condensate (EBC) and serum of all cases were collected. Lung function, arterial blood gases, echocardiography,6-minute walking distance (6MWD),liver and kidney function were assayed in all cases. The levels of high sensitive C-reactive protein (hs-CRP) in serum and EBC were measured by latex enhanced transmission immunoturbidimetric assay. The level of tumor necrosis factor-α (TNF-α) in plasma and EBC were measured by a commercially available sandwich enzyme-linked immunoassay. Forty-five patients with stable COPD complicating PAH were randomly divided into treatment group (n = 23) and control group (n = 22). Two groups both received conventional therapy according to COPD. The former received atorvastatin 20 mg/d, and the latter without atorvastatin treatment. Pulmonary arterial pressure, arterial blood gas, pulmonary function, 6MWD, liver and kidney function were detected and the blood samples and EBC collected before and 6 months after atorvastatin administration. Results The levels of arterial oxygen partial pressure (PaO2) and 6MWD in patients with pulmonary arterial hypertension were significially lower than that in patients without pulmonary arterial hypertension ( P〈0.05). The levels of hs-CRP and TNF-α in serum and EBC were significantly higher in patients with pulmonary arterial hypertension than in patients without pulmonary arterial hypertension (all P 〈 0.05). Pulmonary artery systolic pressure (PASP) in PAH group was positively correlated with the levels of hs-CRP and TNF-α both in serum and EBC ( r =0. 350- 0. 598,all
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