| Objective:Chronic pulmonary heart disease,short for chronic cor pulmonale,is a common chronic respiratory disease,which would cause permanent damages to both lung function and cardiac function of patients and have a serious impact on their quality of life and life span with the worsening of the disease finally.So far,the pathogenesis of chronic cor pulmonale has not yet entirely clear,but widely accepted is that hypoxic pulmonary hypertension is the essential precondition of its occurrence and development.hypoxic pulmonary hypertension contains two important pathophysiological changes,namely hypoxic pulmonary vasoconstriction and hypoxic pulmonary vascular remodeling,which the latter often changes the anatomical structure of pulmonary vessels and cause pulmonary hemodynamic disorder.Hypoxic pulmonary vascular remodeling is a determinantof pulmonary hypertension from reversible to persistent,and it is alsoa difficult point in the treatment of pulmonary hypertension.Transforming growth factor ?1(TGF-?1),a newly discovered cytokine that regulates cell growth and differentiation,has an obvious effect on promoting fibrosis and tissue remodeling,which can cause the proliferation,hypertrophy,rearrangement,migration,apoptosis of vascular parenchyma cells and the increase of extracellular matrix.Some current studies show that TGF-?1and its m RNA in bronchial mucosa,lung tissue,pulmonary vascular wall,bronchoalveolar lavage fluid,serum of hypoxia-induced animal model of chronic cor pulmonale are both in a higher level,which suggests that hypoxia probably increases the expression of TGF-?1and that activated TGF-?1plays an important role in the occurrence and development of pulmonary hypertension and cor pulmonale.Then it can be inferred that the serum levels of TGF-?1in patients with chronic cor pulmonale may also be higher.In this study,the serum TGF-?1levels of 90 patients with chronic cor pulmonale during different stages(acute exacerbation stage and remission stage)and 90 healthy subjects are measured.Through analyzing the correlation among the TGF-?1levels and arterial oxygen partial pressure(Pa O2)and right cardiac ultrasonic indexes reflecting the degrees of pulmonary hypertension or right ventricular enlargement including the main pulmonary artery diameter(MPAD),right ventricular diameter(RVD)and pulmonary artery systolic pressure(PASP),the effect of TGF-?1on Chronic cor pulmonale can be further researched and a new clinical thinking to prevent and cure the disease is provided probably.Methods:90 patients with acute exacerbation of chronic cor pulmonale including62 males and 28 females acted as acute exacerbation group(mean age,69.77 ± 7.24 years),after conventional treatment to alleviate as remission group.90 gender-and age-matched healthy subjects served as a healthy control group.The serum TGF-?1levels of each group were tested by Enzyme-Linked Immuno Sorbent Assay(ELISA),which applied statistical SPSS19.0 software to carry out one-way ANOVA.Right cardiac parameters with different stages of patients with chronic cor pulmonale were measured with color doppler echocardiography,including MPAD,RVD and PASP,and the Pa O2 levels by arterial blood gas analysis,Which the above measured indexes all carried out the correlation analysis with serum TGF-?1levels.Results:1.general information general information90 patients with acute exacerbation of chronic cor pulmonale including62 males and 28 females,the average age is(69.77 ± 7.24)years.The average main pulmonary artery diameter(MPAD)is(25.97 ± 3.37)mm,the average right ventricular diameter(RVD)is(26.43 ± 2.99)mm,and the average pulmonary artery systolic pressure(PASP)is(54.41 ± 6.85)mm Hg.90 patients in the remission stage of chronic cor pulmonale,the average main pulmonary artery diameter(MPAD)is(25.07 ± 3.38)mm,the average right ventricular diameter(RVD)is(26.45 ± 3.67)mm,and the average pulmonary artery systolic pressure(PASP)is(49.36 ± 6.86)mm Hg.90 healthy controls including 60 males and 30 females,theaverage age is(68.90 ± 5.79)years.The average main pulmonary artery diameter(MPAD)is(19.13 ± 2.84)mm,and the average right ventricular diameter(RVD)is(20.31 ± 4.11)mm.2.serum TGF-?1levels of each group The levels of TGF-?1in serum of patients with chronic cor pulmonale in acute exacerbation group is(7)306.12 ± 27.04(8)pg/ml,in remission group(7)161.16 ± 24.00(8)pg/ml,in health contrast group(7)82.15 ± 24.34(8)pg/ml.The differences among the groups is all statistically significant(P < 0.05).3.Correlation between serum TGF-?1levels and Pa O2 in different stages of patients with chronic cor pulmonale The levels of TGF-?1in serum of patients with chronic cor pulmonale both in acute exacerbation stage and in remission stage is negatively correlated with Pa O2(r =-0.739,P < 0.05;r =-0.619,P < 0.05).And the Pa O2 levels in acute exacerbation stage [(58.35±9.36)mm Hg] are less than those in remission stage [(78.23±8.07)mm Hg],significantly statistical difference between the two stages(P < 0.05).4.Correlation among the serum TGF-?1levels and right cardiac parameters of echocardiography(including PMAD,RVD and PASP)in different stages of patients with chronic cor pulmonale The levels of TGF-?1in serum of patients in acute exacerbation stage are positively correlated with MPAD,RVD and PASP(r =0.740,P < 0.05;r =0.792,P < 0.05;r =0.878,P < 0.05).And the serum levels of TGF-?1in remission stage are also correlated with MPAD,RVD and PASP(r =0.600,P < 0.05;r=0.718,P < 0.05;r =0.630,P < 0.05).Conclusions:1.The serum TGF-?1levels in patients with chronic cor pulmonale are significantly higher than those of healthy control group and it is positively correlated with ultrasonic parameters reflecting pulmonary hypertension and right ventricular enlargement,which shows that TGF-?1is possibly involved in the pathophysiological process of chronic cor pulmonale.2.The serum TGF-?1levels in patients with chronic cor pulmonale are negatively correlated with Pa O2,which shows the increase of the levels of TGF-?1is probably related to hypoxia stimulation.3.The levels of TGF-?1in serum of patients with chronic cor pulmonale disease in acute exacerbation stage are evidently higher than those in remission stage,which suggests that the levels of TGF-?1may be used as a new method for evaluating the condition and curative effect of patients with chronic cor pulmonale.4.In view of the above-mentioned findings,the significant decrease of serum TGF-?1levels is closely related to hypoxia and probably paticipates in the pathological changes of right cardiac system,which it may provide a new thinking for the prevention and treatment of chronic cor pulmonale by inhibiting its signal transduction or biological activity. |
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