肺疾病,阻塞性,慢性%急性加重期%肺源性心脏病%肺动脉高压%红景天%葛根素%高海拔
肺疾病,阻塞性,慢性%急性加重期%肺源性心髒病%肺動脈高壓%紅景天%葛根素%高海拔
폐질병,조새성,만성%급성가중기%폐원성심장병%폐동맥고압%홍경천%갈근소%고해발
Chronic obstructive pulmonary disease in acute exacerbation%Cor pulmonale%Pulmonary arterial hypertension%Rhodioside%Puerarin%High altitude
目的探讨红景天和葛根素对高原地区慢性阻塞性肺疾病急性加重期(AECOPD)合并慢性肺源性心脏病(CCP)患者肺动脉高压(PAH)的干预效果.方法采用前瞻性随机对照研究方法.按随机数字表法将138例高原地区(海拔2260~3500 m)AECOPD合并CCP患者分为对照组、红景天治疗组和葛根素治疗组,每组46例.3组患者均给予抗感染、祛痰、平喘、吸氧等常规治疗,在此基础上,红景天治疗组口服红景天胶囊,每次2.0 g,每日3次,共28 d;葛根素治疗组静脉滴注葛根素,每次0.2 g,每日1次,共28 d.于治疗前和治疗14 d、28 d分别测定血中内皮素-1(ET-1)、一氧化氮(NO)、一氧化氮合酶(NOS)水平及平均肺动脉压(mPAP)、右心室流出道(RVOT)、右心室内径(RVID)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2).结果3组治疗前ET-1、NO、NOS、mPAP、RVOT、RVID、PaO2、PaCO2比较差异均无统计学意义(均P>0.05);随治疗时间延长,3组ET-1、mPAP、RVOT、RVID、PaCO2均显著降低,NO、NOS和PaO2显著升高,治疗28 d达谷值或峰值.红景天治疗组和葛根素治疗组治疗14 d、28 d各指标与对照组比较差异均有统计学意义(P<0.05或P<0.01),且治疗28 d时红景天治疗组各项指标改善程度均较葛根素治疗组为优〔ET-1(μg/L):63.9±9.1比74.8±9.8,mPAP(mm Hg,1 mm Hg=0.133 kPa):32.4±4.6比38.2±4.8,RVOT(mm):31.3±3.2比33.6±3.3,RVID(mm):24.3±2.8比27.7±2.8,PaCO2(mm Hg):42.5±5.1比46.7±5.2,NO(μmol/L):70.3±9.1比58.2±8.3,NOS(μmol/L):25.6±2.8比20.5±2.7,PaO2(mm Hg):54.9±5.6比50.8±5.5〕,差异均有统计学意义(均P<0.01).直线相关分析显示,ET-1与mPAP呈显著正相关(r=0.838,P<0.01),与NO、PaO2呈显著负相关(r1=-0.802,r2=-0.765,均P<0.01);NO与mPAP呈显著负相关(r=-0.835,P<0.01),与PaO2呈显著正相关(r=0.743,P<0.01).结论红景天和葛根素治疗高原地区AECOPD合并CCP患者的PAH是有效的,且红景天疗效更好,其机制可能是它们对肺血管内皮细胞ET-1合成、释放的抑制,而对NO合成与释放的促进,调节了舒/缩血管物质的失衡,从而使PAH降低.
目的探討紅景天和葛根素對高原地區慢性阻塞性肺疾病急性加重期(AECOPD)閤併慢性肺源性心髒病(CCP)患者肺動脈高壓(PAH)的榦預效果.方法採用前瞻性隨機對照研究方法.按隨機數字錶法將138例高原地區(海拔2260~3500 m)AECOPD閤併CCP患者分為對照組、紅景天治療組和葛根素治療組,每組46例.3組患者均給予抗感染、祛痰、平喘、吸氧等常規治療,在此基礎上,紅景天治療組口服紅景天膠囊,每次2.0 g,每日3次,共28 d;葛根素治療組靜脈滴註葛根素,每次0.2 g,每日1次,共28 d.于治療前和治療14 d、28 d分彆測定血中內皮素-1(ET-1)、一氧化氮(NO)、一氧化氮閤酶(NOS)水平及平均肺動脈壓(mPAP)、右心室流齣道(RVOT)、右心室內徑(RVID)、動脈血氧分壓(PaO2)、動脈血二氧化碳分壓(PaCO2).結果3組治療前ET-1、NO、NOS、mPAP、RVOT、RVID、PaO2、PaCO2比較差異均無統計學意義(均P>0.05);隨治療時間延長,3組ET-1、mPAP、RVOT、RVID、PaCO2均顯著降低,NO、NOS和PaO2顯著升高,治療28 d達穀值或峰值.紅景天治療組和葛根素治療組治療14 d、28 d各指標與對照組比較差異均有統計學意義(P<0.05或P<0.01),且治療28 d時紅景天治療組各項指標改善程度均較葛根素治療組為優〔ET-1(μg/L):63.9±9.1比74.8±9.8,mPAP(mm Hg,1 mm Hg=0.133 kPa):32.4±4.6比38.2±4.8,RVOT(mm):31.3±3.2比33.6±3.3,RVID(mm):24.3±2.8比27.7±2.8,PaCO2(mm Hg):42.5±5.1比46.7±5.2,NO(μmol/L):70.3±9.1比58.2±8.3,NOS(μmol/L):25.6±2.8比20.5±2.7,PaO2(mm Hg):54.9±5.6比50.8±5.5〕,差異均有統計學意義(均P<0.01).直線相關分析顯示,ET-1與mPAP呈顯著正相關(r=0.838,P<0.01),與NO、PaO2呈顯著負相關(r1=-0.802,r2=-0.765,均P<0.01);NO與mPAP呈顯著負相關(r=-0.835,P<0.01),與PaO2呈顯著正相關(r=0.743,P<0.01).結論紅景天和葛根素治療高原地區AECOPD閤併CCP患者的PAH是有效的,且紅景天療效更好,其機製可能是它們對肺血管內皮細胞ET-1閤成、釋放的抑製,而對NO閤成與釋放的促進,調節瞭舒/縮血管物質的失衡,從而使PAH降低.
목적탐토홍경천화갈근소대고원지구만성조새성폐질병급성가중기(AECOPD)합병만성폐원성심장병(CCP)환자폐동맥고압(PAH)적간예효과.방법채용전첨성수궤대조연구방법.안수궤수자표법장138례고원지구(해발2260~3500 m)AECOPD합병CCP환자분위대조조、홍경천치료조화갈근소치료조,매조46례.3조환자균급여항감염、거담、평천、흡양등상규치료,재차기출상,홍경천치료조구복홍경천효낭,매차2.0 g,매일3차,공28 d;갈근소치료조정맥적주갈근소,매차0.2 g,매일1차,공28 d.우치료전화치료14 d、28 d분별측정혈중내피소-1(ET-1)、일양화담(NO)、일양화담합매(NOS)수평급평균폐동맥압(mPAP)、우심실류출도(RVOT)、우심실내경(RVID)、동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2).결과3조치료전ET-1、NO、NOS、mPAP、RVOT、RVID、PaO2、PaCO2비교차이균무통계학의의(균P>0.05);수치료시간연장,3조ET-1、mPAP、RVOT、RVID、PaCO2균현저강저,NO、NOS화PaO2현저승고,치료28 d체곡치혹봉치.홍경천치료조화갈근소치료조치료14 d、28 d각지표여대조조비교차이균유통계학의의(P<0.05혹P<0.01),차치료28 d시홍경천치료조각항지표개선정도균교갈근소치료조위우〔ET-1(μg/L):63.9±9.1비74.8±9.8,mPAP(mm Hg,1 mm Hg=0.133 kPa):32.4±4.6비38.2±4.8,RVOT(mm):31.3±3.2비33.6±3.3,RVID(mm):24.3±2.8비27.7±2.8,PaCO2(mm Hg):42.5±5.1비46.7±5.2,NO(μmol/L):70.3±9.1비58.2±8.3,NOS(μmol/L):25.6±2.8비20.5±2.7,PaO2(mm Hg):54.9±5.6비50.8±5.5〕,차이균유통계학의의(균P<0.01).직선상관분석현시,ET-1여mPAP정현저정상관(r=0.838,P<0.01),여NO、PaO2정현저부상관(r1=-0.802,r2=-0.765,균P<0.01);NO여mPAP정현저부상관(r=-0.835,P<0.01),여PaO2정현저정상관(r=0.743,P<0.01).결론홍경천화갈근소치료고원지구AECOPD합병CCP환자적PAH시유효적,차홍경천료효경호,기궤제가능시타문대폐혈관내피세포ET-1합성、석방적억제,이대NO합성여석방적촉진,조절료서/축혈관물질적실형,종이사PAH강저.
Objective To investigate the intervention effectiveness of rhodioside and puerarin on pulmonary arterial hypertension(PAH)in patients with chronic obstructive pulmonary disease in acute exacerbation(AECOPD) stage complicated by chronic cor pulmonale(CCP)at high altitude areas. Methods A prospective randomized clinical contrast method was conducted. Designed with random digits table method,138 patients with AECOPD and CCP at high-altitude(2260-3500 m above sea level)were divided into three groups(each,n=46):control group, rhodioside treated group and puerarin treated group. All patients in the three groups received routine treatment of anti-infection,expectorant,antiasthma,oxygen,etc. therapies. Each patient in rhodioside treated group received 2.0 g of rhodioside orally,3 times daily,in puerarin treated group received 0.2 g of puerarin by intravenous drip,once daily, and in control group received routine treatment,the therapeutic course being 28 days in all the three groups. Levels of endothelin-1(ET-1),nitric oxide(NO),nitric oxide synthesis(NOS),mean pulmonary arterial pressure(mPAP), outflow tract of right ventricle(RVOT),internal diameter of right ventricle(RVID),partial pressure of arterial oxygen (PaO2)and partial pressure of arterial carbon dioxide(PaCO2)were measured before treatment and on the 14th day, and 28th day after treatment. Results Before treatment,levels of ET-1,NO,NOS,mPAP,RVOT,RVID, PaO2 and PaCO2 showed no significant differences among three groups(all P>0.05). Along with the prolongation of therapeutic time,compared with those before treatment,the plasma levels of ET-1,mPAP,RVOT,RVID,and PaCO2 on the 14th day and 28th day after treatment were significantly decreased in the three groups,however the levels of NO,NOS,and PaO2 were significantly increased. The above parameters reached their valley or peak values on the 28th day after treatment in the three groups. All parameters on the 14th day and 28th day in rhodioside treated group and puerarin treated group had significant differences compared with those in the control group(P<0.05 or P<0.01), 28th day after treatment,the improvement in rhodioside treated group being more obvious than that in puerarin treated group〔ET-1(μg/L):63.9±9.1 vs. 74.8±9.8,mPAP(mm Hg,1 mm Hg=0.133 kPa):32.4±4.6 vs. 38.2±4.8, RVOT(mm):31.3±3.2 vs. 33.6±3.3,RVID(mm):24.3±2.8 vs. 27.7±2.8,PaCO2(mm Hg):42.5±5.1 vs. 46.7±5.2,NO(μmol/L):70.3±9.1 vs. 58.2±8.3,NOS(μmol/L):25.6±2.8 vs. 20.5±2.7,PaO2(mm Hg):54.9±5.6 vs. 50.8±5.5〕,there were statistical significant differences(all P<0.01). Correlation analyses showed that the level of ET-1 was significantly positively correlated with mPAP(r=0.838,P<0.01),and was significantly negatively correlated with NO and PaO2(r1=-0.802,r2=-0.765,both P<0.01);the level of NO was significantly negatively correlated with mPAP(r=-0.835,P<0.01),and was significantly positively correlated with PaO2 (r=0.743,P<0.01)in 138 patients with AECOPD and CCP. Conclusions Rhodioside and puerarin are effective in treatment of PAH in patients with AECOPD complicated by CCP at high altitude,and the effect of rhodioside is more effective than puerarin. The mechanism of the therapy is probably related to the inhibition of ET-1 synthesis or release and promotion of NO synthesis or release from lung vascular endothelial cells that can regulate the imbalance between vascular dilative and constrictive substances,thus PAH is descendent.
