| Objective: Suffering from autoimmune diseases are often associated withsecondary Raynaud’s phenomenon,and,Raynaud’s phenomenon is often typicalclinical features of autoimmune diseases.Raynaud’s phenomenon inmicrovascular vasomotor dysfunction, hypoxia,ischemia,necrosis was themain features,and organ damage in particular is closely related withpulmonary hypertension and proteinuria.The onset of Raynaud’s phenomenoncaused by connective tissue disease (CTD) rate is high, but the poor treatmenteffect. Therefore, the current drug to find an effective treatment of Raynaud’sphenomenon and improve the prognosis of the countries has been a concern ofscholars. Recently,with a large number of vasodilator drugs,drug treatment ofconnective tissue disease caused by the phenomenon of Renault has madegreat progress.Prostacyclin (PGI2) has significant vasodilation and inhibitionof platelet aggregation.The clinical findings,prostacyclin derivativesalprostadil injection can dilate blood vessels,inhibit thrombosis,improvecirculation and regulating the balance of vasoactive substances,has beenapproved by the public.In the brain, heart, cerebrovascular disease werereported,but the application in Raynaud’s phenomenon of connective tissuedisease caused by the no reliable evidence.As everyone knows:PGI2is thethromboxane A2(TXA2) physiological antagonist,under normal physiologicalconditions,TXA2and PGI2to maintain the dynamic balance,stability is ofgreat significance in the maintenance of vascular homeostasis,but because thePGI2has a very short half-life,the present study is through the PGI2stablemetabolites6-keto prostaglandin (6-keto-PGF1a) as judge its concentrationindex. In addition,calcitonin gene related peptide (CGRP) is the best known inthe vasodilator substances,and to promote vascular endothelial cell proliferation and regulation of cellular immune function in a variety of roles,one of the main target organ of CGRP is kidney,there are abundant CGRPreceptor in renal vascular bed;5-hydroxytryptamine (5-HT) as a pulmonaryvasoactive factors,can cause pulmonary vasoconstriction,also can increase thepulmonary artery smooth muscle cell DNA synthesis,there was a positivecorrelation between changes in change there are many reported that theconcentration of5-HT and pulmonary artery pressure.This study is through thedetermination of healthy people and connective tissue disease due to theforefront of Raynaud’s phenomenon in patients before and after treatment intreatment of peripheral blood6-keto-PGF1a,CGRP,5-HT level,to furtherexplore the pathogenesis of Raynaud’s phenomenon,evaluation of organdamage and the curative effect of alprostadil,provide evidence for clinicalmedication.Methods:1Selection of subjects in34cases，(1)Group A (connective tissue diseasesecondary RP group):Age16~70years old,all the patients met the AmericanCollege of Rheumatology connective tissue disease classification standard andwith Raynaud’s phenomenon, no serious infections.In order to understand therelationship between gender and different diseases, divided into group C1(male group) and5cases of group C2(female group)29cases;to explore therelationship between serum6-keto-PGF1a,CGRP,5-HT levels and organdamage,according to the pulmonary artery pressure in2003established inVenice Conference (PAH) classification and diagnosis standard,understanding in patients with connective tissue disease secondary Raynaud’sphenomenon is associated with PAH,(PAH diagnostic criteria:severity of PAHgrade:30~40mmHg41~70mmHg for mild,moderate,≥71mmHg andaccompanied by chest tightness, dyspnea symptoms or on the basis of theappearance of right heart failure was severe.)Pulmonary artery pressure≥30mmHg as positive.According to whether the pulmonary hypertension weredivided into group D1(CTD combined PAH group)17cases and group D2 (CTD not with PAH group)17cases;and according to the presence or absenceof albuminuria were divided into group E1(CTD proteinuria group)5casesand group E2(CTD is not associated with proteinuria group)29cases.(2): Atreatment group selected cases of routine use of hormones andimmunosuppressive therapy,and the application of alprostadil injection(Beijing Taide pharmaceutical company production,trade name Kaishi)10vg,intravenous injection,1times a day,a total of10days.(3) and group B(control group):20cases of healthy volunteers,average age is18~70yearsold,no connective tissue disease and other family disease history, a history ofcerebrovascular and severe infection.2Application of6-keto-PGF1a in peripheral blood were measured withradioimmunoassay,connective tissue disease in patients with Raynaud’sphenomenon and healthy volunteers before and after the administration ofCGRP level analysis method,serum5-HT levels were measured byfluorescence spectrophotometry,treatment group were recorded age,sex,24hour urinary protein quantity,blood routine,urine routine,immunoglobulin,complement C3,C4,erythrocyte sedimentation rate (ESR),C-reactive protein(CRP),cardiac ultrasound estimation of pulmonary artery pressure in group A,pulmonary interstitial fibrosis.3Data processing: application of SPSS13.0statistical softwareprocessing, general data in (x±s) said,compared with two samples ofmeasurement data, if accord with normal distribution and equal varianceaccording to specific groups using t test for paired data of two independentsample t test and,if you do not meet with rank sum test,P<0.05the differencewas statistically significant.Analysis of the correlation between two variablesby using Pearson analysis method.Results:1Group A(connective tissue disease secondary RP group)of peripheralserum6-keto-PGF1a expression level was (469.83±276.35)pg/ml,group B(control group)of peripheral serum6-keto-PGF1a expression level was(91.92±41.53) pg/ml,group A was significantly higher than that in group B,P<0.05, difference has statistical significance;group A (connective tissue diseasesecondary RP group)of peripheral serum CGRP expression level was(68.22±26.53) pg/ml,group B(control group) of peripheral serum CGRP expressionlevel was (97.93±10.39) pg/ml,group A was lower than that of group B,P<0.05,and the difference was statistically significant;group A(connectivetissue disease secondary RP group) of peripheral serum5-HT expression levelwas (34.84±6.29) pg/ml,group B (control group) of peripheral serum5-HTexpression level was (28.81±3.40) pg/ml, group A than in group B,P<0.05, thedifference was statistically significant.2After treatment,serum6-keto-PGF1a expression level was(397.57±300.12) pg/ml,after treatment than before treatment decreased,but P>0.05,nosignificant difference;after treatment,serum CGRP expression level was(72.60±33.80) pg/ml, slightly higher after treatment than before treatment,P>0.05,difference no statistically significant;after treatment,serum5-HT expressionlevel was(31.69±7.01)pg/ml,lower after treatment than before treatment,P<0.05,the difference was statistically significant.3Group C1(male)and the level of group C26-keto-PGF1a expression ofperipheral serum (female group)6-keto-PGF1a level variance not neatexpression of peripheral serum,rank sum test applications,no significantdifference (P>0.05);group C1(male group) of peripheral serum CGRPexpression level was (85.03±7.68)pg/ml,group C2(female group) of peripheralserum CGRP expression level was (60.90±21.22)pg/ml,were higher in malesthan in females,but P>0.05,no significant difference;group C1(male) ofperipheral serum5-HT expression level was(40.27±2.02) pg/ml,group C2(female group) of peripheral serum the expression level of5-HT is (31.15±4.41) pg/ml,male is higher than female,P>0.05,no significant difference.4Group D1of peripheral serum6-keto-PGF1a expression level was(440.50±177.74)pg/ml,group D2of peripheral serum6-keto-PGF1aexpression level was (609.68±1.70) pg/ml,CTD with PAH group is lowerthan that of patients without PAH group P>0.05,however,no significantdifference;group D1of peripheral serum CGRP expression level was(68.50± 27.28)pg/ml,group D2of peripheral serum CGRP expression level was(68.02±24.92)pg/ml,CTD with PAH group higher than those of patients withoutPAH group,P>0.05,no significant difference;group D1of peripheral serum5-HT expression level was(37.31±4.40)pg/ml,group D2of peripheral serum5-HT expression level was(34.07±3.66)pg/ml,CTD with PAH group higherthan those of patients without PAH group,P>0.05,no significant difference.5Peripheral serum6-keto-PGF1a expression level in group E1was(490.75±387.65)pg/ml,peripheral serum6-keto-PGF1a expression level ingroup E2was (442.24±95.98)pg/ml,CTD with proteinuria group higher thanthose of patients without proteinuria group,P<0.05,the difference wasstatistically significant;peripheral serum CGRP expression level in group E1was (60.51±15.38)pg/ml,peripheral serum CGRP expression level in group E2was (70.63±14.81)pg/ml,CTD with proteinuria group was lower than that ofwithout proteinuria group,P>0.05,no significant difference;the expressionlevel of5-HT in group E1compared with group E2in the peripheral serum,P>0.05no significant difference.6Correlation analysis:The test value was positively correlated with serum5-HT level andconnective tissue disease caused by high pressure of pulmonary artery.Conclusions:16-keto-PGF1a and5-HT levels in serum of patients with connectivetissue diseases caused by Raynaud’s phenomenon is higher than the healthycontrol group,PGI2and5-HT are involved in the pathogenesis of connectivetissue disease caused by the phenomenon of reynolds.2The level of serum CGRP in patients with connective tissue diseasescaused by Raynaud’s phenomenon is lower than that of the healthy controlgroup, lower CGRP level plays a certain role in the pathogenesis of connectivetissue disease caused by the phenomenon of Reynolds3Alprostadil injection can reduce the patients with connective tissue diseases caused by RP5-HT levels, alprostadil injection is effective for thetreatment of diseases caused by Raynaud’s phenomenon of connective tissue. |
PDF Full Text Request