A Clinical Study On The Relationship Between Serum Basic Fibroblast Growth Factor, Nitric Oxide And Chronic Cor Pulmonale

Background and objectives Hypoxic pulmonary hypertension(HPH)is the prerequisit for the pathogenesis of chronic cor pulmonale(CCP),which includes two important pathophysiologic changes :hypoxic pulmonary vasoconstriction and vascular structural remodeling,especially the latter is the determinant of the sustained hypoxic pulmonary hypertension. Studies suggest that many active material and several growth factors may be invovlved in the process of vascular structural remodeling. Basic fibroblast growth factor(bFGF) and nitric oxide(NO) are the two of them. bFGF can promote the proliferation and migration of vascular smooth cells and the growth of endothelial cells,increase the synthesis of elastin,and inhibit the cell apoptosis.And NO can inhibit proliferation of vascular smooth cells and relaxing them.lt can also promote apoptosis of vascular smooth cells and inhibit the synthesis of collagens,etc.They may play an important role in the process of sustained pulmonary hypertension in patients with CCP.Therefore,more and more people focused on NO and bFGF.But,whether the serum levels of NO and bFGF changes in patients with CCP and whether there is any relationship between bFGF NO and HPH are not defined.In order to elucidate the pathophysiologic significance of bFGPN NO in CCP and the relationship between NO and bFGF and HPH and to find new treatment for CCP,we measured serum NO and bFGF levels both in acute exacerbation and remission stages in 28 cases with CCP.At the same time we analyse its correlation with themselves and with PaO2 and the ratio of right ventricular pre-ejection period(RVPEP) to the pulmonary flow acceleration time(AT), which reflects the degree of pulmonary hypertension(RVPEP/AT,>1.0 indictingpulmonary hypertension).Subjects and Methods CCP group consists of 28 patients(16 males and 12 females,aged 42 to 74;mean ?SD age, 60 ?12.20years) was classified into two groups(acute exacerbation and remission stage)according to their clinical presentation.28 gender and age matched healthy subjects serve as a normal control group.The serum level of bFGF and NO were respectively determined by enzyme linked immunrosorbent assay(ELISA) and nitric acid reductase.The RVPEP/AT were measured with Doppler echocardiograph and PaO₂ by arterial blood gas assay.Resu I ts (l)The serum bFGF levels in the acute exacerbation and remission stages of CCP group[(67.86?4.86),(55.0?3.66)pg/ml]were both obviously higher than those in the normal control group[(39.88?2.95)pg/ml, P<0.01, P<0.01],and the serum bFGF levels were also higher than those in the remission stage(p<0.01).The serum NO levels in the acute exacerbation and remission stages of CCP group[(70.43 ?.22),( 103.0 + 8.07) μ mol/l]were both significantly lower than those in the normal control group[ (125.66 + 7.43) μ mol/1, P<0.01, P<0.01],and the serum bFGF levels were also lower than those in the remission stage(P<0.01).The PaO₂ levels in the acute exacerbation stage[(51.86 + 6.54)mmHg]were lower than those in the remission stage[(71.29?.36), P<0.01].The values of RVPEP/AT in the acute exacerbation stage(1.55?.18)were higher than those in the remission stage[(1.24?.13), P<0.01].(2)In CCP group ,the serum bFGF levels positively correlated with RVPEP/AT(r=0.80,P=0.007;r=0.73,P=0.001) and negatively correlated with PaO2(r=-0.48, P=0.01;r=-0.43, P=0.024)in the acute exacerbation and remission stages.But the serum NO gets the opposite results constrasting with NO in these two stages.(3) The serum bFGF levels were negatively correlate with NO both hi the acute exacerbation and remission stages (r=-0.39, P=0.038;r=-0.41,P=0.03) .Conclusions (l)The serum levels of bFGF both in the acute exacerbation and remission stages in patients with CCP were higher than those in the normal control group,especially in the former stage;In CCP group,serum bFGF levels positively correlate with RVPEP/AT and negtively correlate with PaO₂ both in the acute exacerbation and remission stages.these findings implies that bFGF take part in the involvement in th...