The Perioperative Expression Of Vascular Active Factor ET-1?cAMP?SDF-1 In Patients Of Rheumatic Mitral Stenosis With Pulmonary Arterial Hypertension And Clinical Research

Objective: Pulmonary arterial hypertension(PAH)is one of the important complications of rheumatic mitral stenosis,its severity is usually associated with poor prognosis and high mortality risk.Therefore,it is very important to improve the understanding?diagnosis and treatment of rheumatic mitral stenosis during perioperative period of PAH.The traditional color Doppler echocardiography is only based on the peak value of tricuspid regurgitation and right atrial pressure.The accuracy of right heart catheterization PAH is high,but it is invasive.Research on endothelin 1(ET-1)?cyclic adenosine monophosphate(cAMP)? stromal cell derived factor 1(SDF-1)expression in the perioperative period of patients with congestive pulmonary arterial hypertension is more,but little research in rheumatic mitral stenosis.In this paper,I have studied the expression of three kinds of vasoactive factors in patients with rheumatic mitral stenosis complicated with PAH and its correlation with preoperative PAH,so as to provide a theoretical basis for the diagnosis?treatment and prognosis of rheumatic mitral stenosis.Methods: This study selected 29 cases of patients with rheumatic mitral stenosis with PAH(undergoing mitral valve replacement surgery),aged 41~69 years old,average 53�9.29 years,preoperative heart function of II ~III(NYHA),excluding idiopathic pulmonary arterial hypertension,congestive pulmonary hypertension,chronic thromboembolic pulmonary hypertension,pulmonary hypertension caused by pulmonary disease,pulmonary vein insufficiency obstruction and blocking,ischemic cardiomyopathy,hepatic and renal insufficiency,serious infectious diseases patients.According to systolic pulmonary artery pressure(SPAP)measured by preoperative color doppler echocardiography,All patients were divided into three groups,9 cases in group A(mild pulmonary arterial hypertension group),SPAP: 36~50mmHg;13 cases in group B(moderate pulmonary arterial hypertension group),SPAP: 50~70mmHg;7 cases in group C(severe pulmonary arterial hypertension group),SPAP: ?70 mmHg.All patients were operated under intravenous inhalational anesthesia?moderate hypothermic and moderate hypothermia.When before anesthesia induction(T1)?CPB stop instantly(T2)?postoperative 12h(T3)? postoperative 24h(T4)? postoperative 48h(T5)? postoperative 72h(T6)?postoperative 120h(T7)and postoperative 168h(T8),all patients were extracted 4 ml blood from elbow,blood samples were put in anticoagulant tube,then sample centrifugal(3000r/min,centrifugal radius of 13.5 cm,10 min),separated plasma to EP tube at-70 degree to be test.After collecting all the samples,using ELISA kit for determination of ET-1?cAMP and SDF-1 concentration.Results: All patients with rheumatic mitral stenosis complicated with PAH,before induction of anesthesia(T1),SPAP and peripheral plasma ET-1?cAMP?SDF-1 of all groups showed a significant difference(P?0.05),the results is:severe pulmonary hypertension group ? moderate pulmonary hypertension group?mild pulmonary hypertension group.The levels of ET-1?c AMP and SDF-1 in peripheral blood increased with the increase of SPAP,and the correlation between cAMP and SDF-1 was more closely related to SPAP.Patients of rheumatic mitral stenosis with PAH,in perioperative period,the level of peripheral blood plasma ET-1 increased firstly and then decreased gradually.C group rose fastest,and the maximum range;B group the second,A group the slowest and minimum.In group A,the time of decline was the earliest,and the rate of decline was the fastest,what happened at postoperative 12h;B group began to decrease at postoperative 24 h,C group began to decrease at postoperative 48 h,and the rate of decline was the slowest.The level of peripheral blood plasma cAMP showed a gradual downward trend,the C group was the slowest,the A group and B group decreased slightly faster.A group decreased by 15.67 nmol/L?B group decreased by 15.21 nmol/L?C group decreased by 14.05 nmol/L.The level of peripheral blood plasma SDF-1 showed a gradual downward trend,A and B groups decreased slightly faster than C group,but in postoperative 168 h,the overall decline is not large.Conclusions:1.patients of rheumatic mitral stenosis with PAH,the level of ET-1?c AMP and SDF-1 in the peripheral plasma increased with the increase of SPAP,and they were positively correlated.2.patients of rheumatic mitral stenosis with PAH,the level of ET-1 in peripheral plasma showed an upward trend in a short time,then decreased gradually,and the rate of decline was negatively correlated with SPAP.3.patients of rheumatic mitral stenosis with PAH,the level of cAMP and SDF-1 in peripheral plasma showed a gradual downward trend.and the rate of decline was negatively correlated with SPAP.