| Objective: Raynaud’s phenomenon (RP) due to a cold or nervousstimulation, acral fine arterial spasm, fingers or toes skin suddenly appearedpale, appeared in succession skin turned purple, red, with partial hair cold,sensory abnormalities and pain, such as short-term clinical phenomenon.Many rheumatological diseases, such as systemic sclerosis, systemic lupuserythematosus may be associated with raynaud’s phenomenon, known assecondary RP.The nature of the RP is abnormal vasoconstriction, circulatorydisorders. Impaired endothelial function is often lesions originating factors.Vasoconstriction active peptide endothelin-1(ET-1) and vascular relaxingfactor nitric oxide (NO) is recognized indicators reflect vascular endothelialfunction. From the synergistic inhibitory role both in the normal case, adynamic equilibrium; vascular endothelial damage, this steady state is to breakthe two vasoactive substances imbalance triggered the development of a seriesof lesions. The clinical findings in patients with raynaud’s phenomenonaddition to the the extremities turned white and purple typical performance,acral ulcers and even gangrene is also very common, high morbidity due toconnective tissue disease. Clinical observations, raynaud’s phenomenon isclosely related to pulmonary hypertension, some scholars have pointed out,connective tissue disease, raynaud’s phenomenon may not only be an earlymanifestation of pulmonary hypertension, but also to promote its furtherdeterioration of the risk factors. The current treatment for Raynaud’s phenol-menon and pulmonary hypertension without special effective medicine, cli-nical findings, vasodilators alprostadil injection can improve the circulation,balance the endothelial repair, regulation of vasoactive subst-ances. The heart,brain, vascular and other diseases have been reported, but the connective tissue disease due to raynaud’s phenomenon is no reliable evi-dence.Thisstudy through the determination of healthy people, and connective tissuedisease in patients with raynaud’s phenomenon caused by application ofalprostadil injection therapy, the peripheral blood of ET-1, NO, nitric oxidesynthase (NOS) induced a the level of nitric oxide synthase (iNOS), to furtherexplore the pathogenesis of raynaud’s phenomenon, the efficacy evaluationalprostadil injection, provide strong evidence for the clinical use of drugs.Methods:1Selected33cases, grouping subjects:(1) group A (RP patient groupdue to connective tissue disease): charge of connective tissue disease with33cases of hospitalized patients with raynaud’s phenomenon, in line withconnective tissue disease diagnostic criteria, no serious infections. Male orfemale, age:16to70years old. Group A was divided into I. group A beforetherapy: patients of group A is not corticosteroids, immunosuppressants andalprostadil injection medication; II. group A after therapy: Selected cases ofgroup A in conventional hormones, immunosuppressants treatment at thesame time, the application of alprostadil injection (Beijing Taidepharmaceutical company production, trade name Kaishi)10vg intravenous,every day, a total of10days.(2) group B (healthy control group) included18cases, select the gender and age-matched healthy volunteers.2Radioimmunoassay determination due to connective tissue diseasebefore and after treatment in patients with raynaud’s phenomenon andperipheral blood of healthy volunteers ET-1levels, nitric acid enzymereduction assay peripheral NO, NOS, iNOS level, and at the same time recordthe patient’s clinical manifestations (mainly include fever, rash, arthritis, hairloss, chest tightness, shortness of breath, etc.) and auxiliary examination(including blood, urine, regular, urinary sediment,24-hour urine protein, liverfunction, kidney function, immune globulin, complement, anti-nuclearantibodies, ENA poly-peptide, echocardiography, pulmonary artery pressure,abdominal ultrasono-graphy, ECG, lung CT). 3Statistical processing: Application SPSS13.0statistical softwareprocessing, general information and data (x±s) or median, the comparison ofthe two-sample measurement data, if they meet the normal distribution andhomogeneity of variance with two independent samples t-test, If you do notqualify for the rank-sum test, the difference was statistically significant atP<0.05. The correlation between the two variables were analyzed usingPearson correlation analysis.Results:1ET-1levels of group A before therapy in peripheral blood wassignificantly higher than that in group B (P<0.05), the difference wasstatistically significant; group A before therapy the peripheral blood NOSlevels and NOS activity was significantly lower than that in group B (P<0.05),The difference was statistically significant; group A before therapy theperipheral blood levels of NO, NO activity and iNOS levels lower than that ingroup B (P>0.05), the difference was not statistically significant; group Abefore therapy iNOS activity in peripheral blood than in group B (P>0.05), thedifference was not statistically significant.2Peripheral ET-1levels and iNOS activity in group A after therapysignificantly lower than before therapy (P<0.05), the difference wasstatistically significant; peripheral blood after therapy, the level of NO, NOvitality, NOS levels, NOS activity are elevated than before treatment (P>0.05),the difference was not statistically significant; the level of iNOS in theperipheral blood after therapy is decreased than before therapy (P>0.05), thedifference was not statistically significant.3ET-1levels in peripheral blood after therapy in group A, the level ofNO, NO vitality, NOS levels, NOS activity, iNOS level and iNOS activitywere lower than in group B (P>0.05), the difference was not statisticallysignificant.4PAH of varying degrees of impact on the ET-1levels in group A(P<0.05), and the difference was statistically significant; NO levels, NOvitality, NOS levels, NOS activity, iNOS level and iNOS activity had no obvious effect (P>0.05), the difference was not statistically significant.Patients of group A with severe the PAH body’s levels of ET-1wassignificantly higher than the non-PAH or associated with mild and moderatePAH patients (P<0.05), the difference was statistically significant; Patients ofgroup A with moderate PAH peripheral blood ET-1levels higher PAH orassociated with mild PAH (P>0.05), the difference was not statisticallysignificant.5Group A peripheral ET-1levels and pulmonary artery pressure(PAP) ispositively correlated (P<0.05), the difference was statistically significant;peripheral blood levels of NO, NO vitality, NOS levels, NOS activity, iNOSlevels, iNOS activity and PAP (P>0.05), the difference was not statisticallysignificant.Conclusions:1Raynaud’s phenomenon in peripheral blood of patients with connectivetissue disease due to ET-1levels were significantly higher than the healthycontrol group, NOS levels, NOS activity was significantly lower than thehealthy control group. ET-1, NOS play a role in the onset of raynaud’sphenomenon.2Application of alprostadil injection therapy can be reduced due toconnective tissue disease in patients with raynaud’s phenomenon in vivo ET-1levels and activity of iNOS, alprostadil injection for the treatment of raynaud’sphenomenon. |
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