A Preliminary Study On The Expression Of Vascular Endothelial Growth Factor In Patients With High Altitude Heart Disease And The Relationship Of Them

Background and purpose:Tibet, with its rich natural and tourism resources, is China’s important strategic region.Heart disease caused by high altitude is always the main threat of the health of peopleliving in highland. Recently, High Altitude Heart Disease (HAHD) has been incorporatedinto the category of occupational disease, because of its high morbidity and poor prognosis.HAHD has brought great suffering to people in high altitude region physically and mentally,causing huge economic burden to the society and military[1]. Many studies have proventhat hypoxic pulmonary hypertension (HPH) plays a key role in HAHD[2]. However, themechanism of HPH is very complicated and hard to be explained by a single mechanism,which involves cells, body fluids, and even molecular genetics. Meanwhile,vasoconstriction and pulmonary vascular structural remodeling (PVSR) are the importantpathophysiological basis of the causing of HPH[4,6]. The previous studies of heart disease inthe highlands are mostly based on clinical analysis. We perform this study in the highlandsand start it with humoral transmitter. By observing clinical symptoms and signs, takingroutine laboratory examination, promoting vascular endothelial growth expression factorlevels and so on, we analyze the clinical features of patients. On studying vascularendothelial growth factor expression level in blood detection, we preliminarily discussthe mechanism of these factors in the pathogenesis of HAHD, so as to provide theoreticbasis for high altitude clinical prevention and treatment.Subjects and Methods:Object:107cases with high altitude heart disease are collected from the outpatients, inpatientsor suspected heart disease inpatients in Tibet military region general hospital from March2012to April2012. According to the inclusion and exclusion criteria,42cases are selected, whose mean age are55years (26years-88years), living in the average altitude4393meters (3700meters-4950meters). Controlling group includes40cases of healthy personsliving in the plateau, the average living altitude4200meter (3658meters-4700meters),with an average age of48years (34years-78years). The high altitude heart diseasecases are in line with the Chinese Medical Association’s diagnostic standard of high altitudeheart disease third high altitude disease Symposium in1995September[10].Objects and methods：Method:1. Group40healthy people are set as the control group, they are collected from the healthexamination center examination plateau in healthy population.42patients from theoutpatient or hospitalization of General Hospital of Tibet military command with highaltitude heart disease are set as the disease group.2. IndexGeneral information of object of our study was collected. Blood, urine routine, liverfunction, kidney function, blood biochemistry, myocardial enzymes and electrocardiogram,chest X-ray and echocardiography and10ml venous blood were collected in the fasting,Specimens were taken from the supernatant at-78℃. hepatocyte growth factor(HGF),vascular endothelial growth factor(VEGF), basic fibroblast growth factor(bFGF),endothelin-1(ET-1), platelet derived growth factor(PDGF), fibroblast growth factor(FGF)of the samples were detected. The examination and collection of specimens were donebefore treatment of disease group.3. DetectionRoutine examination, biochemical examination, electrocardiogram and chest X-rayexamination were processed with the conventional methods. echocardiography check usingthe PHILIPS iE-33color Doppler echocardiography diagnostic apparatus, according to theDoppler spectrum method for calculation of pulmonary artery systolic pressure, et al. HGF,VEGF, bFGF, ET-1, PDGF and FGF were detected according to manufacture’s instructions.4. StatisticsUse SPSSl4.0statistical software, measurement data was described as the mean±standard deviation(x±s), count data was expressed as a percentage, abnormal of electrocardiogram and chest X-ray incidence were compared using analysis of variance,color Doppler numerical, in general, factor levels of between groups were comparedusing independent samples t-test, factor level and systolic pulmonary artery pressure(SPAP)correlation by using linear regression analysis, P＜0.05was considered statisticallysignificant.Results:1. Analysis of general informationthere was no statistical difference in gender, age, living altitude, how long they lived inplateau between disease group and control group.2. Routine laboratory results analysisBy analysis routine clinical laboratory results such as blood routine, liver function,renal function and serum enzyme results of disease group and control group, we found thatthe results of disease group are higher than that of control group, except for TP and ALB,which was significantly lower than that of control group. P＜0.01. There’re no significantdifference between disease group and control group in Stool routine and Urine routine.3. Chest χ examinationThe chest χ ray examination of the disease group show that all42cases of HAHDpatients with significant cardiac enlargement, especially the right heart. There is significantdifference between disease group and control group in chest χ ray examination.4. Comparison of Electrocardiogram between disease group and control groupElectrocardiogram show that all42patients in disease group were with varyingdegrees of abnormal electrocardiogram changes. There’re significant differences betweendisease group and control group in heart rate, rhythm, electrical axis, hypertrophy, andinfarction occurred.5. Comparison of Echocardiography between disease group and control groupEchocardiography examination show that the high altitude heart disease patients hadvarying degrees of pulmonary hypertension and right heart changes, All measuring valuesof disease group were significantly higher than that of control group. P＜0.01.6. Blood vascular endothelial and smooth muscle cell growth factor test results ofdisease group and control groupTest results of blood HGF, VEGF, bFGF, ET-1, PDGF, FGF show the expression of these factors were significantly higher in disease group than that in control group. P＜0.01.7. The relativity between pulmonary arterial systolic pressure and vascular endothelialand smooth muscle cell growth factor of disease group.The correlation test found that the expression level of disease group of HGF, VEGF,bFGF, ET-1, PDGF, FGF was significantly positive correlation with SPAP.Conclusion:1. Electrocardiogram, chest X-ray, echocardiography examination show significantpulmonary hypertension in patients with high altitude heart disease, and state of an illnessare closely related with the severity of pulmonary arterial hypertension. The fact shows thatpulmonary artery hypertensions play an important role in the pathogenesis of HAHD.Indexes of blood routine, liver function, renal function, serum enzyme indicators are allconfirmed that there are multiple organ damage in patients with high altitude heart diseasedue to continuous hypoxia and hypoxia injury.2. Vascular endothelial growth factor HGF, VEGF, bFGF, and vascular smooth musclecell growth factor ET-1, PDGF, FGF expression in the blood of the high altitude heartdisease patient’s were significantly increased. It was positively correlated with the patient’sSPAP. Hence, enhance expression of these factors in the patients with high altitude heartdisease maybe a key factor of PVSR and chronic hypoxic pulmonary hypertension.