Involvement Of Serum Neurotransmitter And Ang Ⅱ In The Pathogenesis Of Pulmonary Encephalopathy

With the boost of living standard, human life span is also lenghened obviously, the morbidity rate of chronic obstructive pulmonary disease(COPD) is increasing, and chronic cor pulmonale is a serious complication of COPD, especially pulmonary encephalopanthy, which seriously influence human quality of life. At present hypoxemia,CO2 retention and acidosis are considered to be the basic pathophysiology of pulmonary encephalopanthy. In addition, the dysfunction of pulmonary microcirculation,pulmonary hypertension,acid-base disturbance and liver dysfunction also take part in the developing of pulmonary encephalopanthy. Recently, more and more important research from epidemiology,pharmacology,psychiatrics,neuropathy medicine,surgery,pediatry,pathophysiology show that hypoxia and acidosis may result in the change of central nervous system neurotransmitter, which may aggravate brain disorder and dysbolism. The monoamine is produced by central nervous system and periphery, but they belong to different system. It is difficult to monitoring the change of neurotransmitter in the brain, so the alteration and determination of perphery neurotransmitter are hot of medical science research. More and more research found that the pathogenisis of cerebrovascucular disease,psyche disease,anoxic ischemic encephalopathy,hepatic encephalopathy et al is correlated with neurotransmitter. But the research of the relationship betweenneurotransmitter and the pathogenisis of pulmonary encephalopanthy is less.Dopamine,5-HT and angiotensinâ…¡( Angâ…¡) also play an important role in pulmonary circulation which result in pneumocardial disease.Objective: To explore the relationship between the serum level of dopamine,5-HT and Angâ…¡a nd pulmonary encephalopathy, and their roles in the pulmonary encephalopathy, which privide a new way to treat and judge the prognosis of pulmonary encephalopathy.Method:All subjects except the patients of complicating cerebral infarction,brain hemorrhage,epilepsy,intracranial infection or tumor,cerebral trauma,hypertension and heart failure of coronary heart disease.All subjects quiet lying in bed after 1.5 hours,and get venous blood. All subjects are devided 3 groups: pulmonary encephalopathy group(16case), hypoxia group(19cases), control group(40cases). The level of dopamine,5-HT and Angâ…¡in serum were mesured by fluorescence detection method and radio immunoassay respectively, and the level level of pH,PaO2,PaCO2,SaO2 were measured by automatic blood gas system.Results:1).The blood gas results showed that PCO2 in pulmonary encephalopathy group was higher than that of hypoxia group, and the PO2,pH and SaO2 were lower than that of hypoxia group. The PO2 and SaO2 in hypoxia group was lower than that of control group, but PCO2 and pH has no change. 2)The count of platelet in pulmonary encephalopathy group is lower than that of control and hypoxia group. 3)The level of dopamine in pulmonary encephalopathy group was higher than that of control group. The level of dopamine in hypoxia group had a higher tendency compared with control group, but no significance. 4).The levels of 5-HT in hypoxia group was higher than that of pulmonary encephalopathy group and control group, while the levels of 5-HT in pulmonaryencephalopathy group was lower than that of control group. 5)The levels of Angâ…¡in hypoxia group was higher than that of control group, while the levels of Angâ…¡in pulmonary encephalopathy group was higher than that of hypoxia group and control group. 6)The PCO2 was positive correlation with Angâ…¡and dopamine, but negative correlation with 5-HT and count of platelet. The PO2 was positive correlation with Angâ…¡,5-HT and count of platelet.Conclusion:1. The levels of 5-HT in hypoxia group was higher than that of control group, because the ability of uptake or inactivate 5-HT in lung is decreasing due to hypoxia. The levels of 5-HT in pulmonary encephalopathy group was lower than that of control group. The reason is that the count of platelet is decreasing in circulation.2.The increasing DA and decreasing 5-HT can result in dysfunction of cerebral vessels, then aggravate pulmonary encephaplopathy.3. The increasing Angâ…¡may aggravate pulmonary encephalopathy by facilitating formation of pulmonary hypertention or taking part in formation of cerebral edema directly.4.Further study indicated that the increased PCO2 was positive correlation with Angâ…¡and dopamine, but it was negative correlation with 5-HT and the count of platelet. The hpoxia was positive correlation with 5-HT and Angâ…¡.So it is very helpful to monitor the DA,5-HT and Angâ…¡for the diagnosing pulmonary encephalopathy and assessment of brain injury. It is also very helpful for the assessment of prognosis and therapy.