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目的:研究30例风湿性心脏病二尖瓣狭窄患者经皮球囊二尖瓣扩张术(PBMV)前、后血浆一氧化氮(NO)、内皮素(ET)及血流动力学变化。方法:用化学比色法、放射免疫分析法分别测定患者 PBMV前、后的NO、ET的血浆浓度;用二维彩色多普勒超声和心导管测定二尖瓣瓣口面积(MVA)、左心房内径(LAD)、平均二尖瓣压力阶差(mMPG)、肺动脉平均压(mPAP)和左房平均压(mLAP)。结果: NO 浓度术前及术后分别为(107.350±33.614)、(74.462±23.913)μmol/L; ET 浓度术前及术后分别为(131.632±43.284)、(100.147±31.904)ng/L。NO、ET浓度术后明显低于术前( 均P<0.01)。术前MVA、LAD及mLAP、mMPG、mPAP分别为(1.026±0.201)cm2、(5.168±0.548)cm及(2.765±0.597)、(1.748±0.729)、(5.601±0.728)kPa;术后分别为(1.725±0.248)cm2、(4.895±0.585)cm及(1.738±0.418)、(0.862±0.415)、(4.155±0.436)kPa。术后血流动力学较术前有明显改善(均P<0.05),血浆NO浓度与 mLAP、mPAP呈正相关( r分别为 0.564、0.453,均 P<0.01);血浆ET浓度与mLAP、mPAP也呈正相关( r分别为0.527、0.528,均P<0.01);且 NO、ET浓度与心功能有关。结论:NO、ET可作为判断风湿性心脏病二尖瓣狭窄病情和PBMV疗效及心功能的良好指标。
Objective: To study the changes of plasma nitric oxide (NO), endothelin (ET) and hemodynamics before and after percutaneous balloon mitral valvuloplasty (PBMV) in 30 patients with mitral stenosis of rheumatic heart disease. Methods: Plasma concentrations of NO and ET before and after PBMV were measured by chemical colorimetry and radioimmunoassay. Mitral valve area (MVA) was measured by two-dimensional color Doppler ultrasound and cardiac catheterization. Atrial diameter (LAD), mean mitral pressure gradient (mMPG), mean pulmonary artery pressure (mPAP) and left atrium mean pressure (mLAP). Results: The preoperative and postoperative levels of NO were (107.350 ± 33.614) and (74.462 ± 23.913) μmol / L, respectively. The pre and postoperative ET concentrations were (131.632 ± 43.284) and (100.147 ± 31.904) ng / L, respectively. The concentrations of NO and ET were significantly lower than those before operation (all P <0.01). The preoperative MVA, LAD and mLAP, mMPG and mPAP were (1.026 ± 0.201) cm2, (5.168 ± 0.548) cm and (2.765 ± 0.597), (1.748 ± 0.729) and (5.601 ± 0.728) kPa, respectively (1.725 ± 0.248) cm2, (4.895 ± 0.585) cm and (1.738 ± 0.418), (0.862 ± 0.415) and (4.155 ± 0.436) kPa, respectively. Postoperative hemodynamics were significantly improved compared with those before operation (all P <0.05). Plasma NO concentration was positively correlated with mLAP and mPAP (r = 0.564, 0.453, all P <0.01) (R = 0.527, 0.528, respectively, P <0.01). The concentrations of NO and ET were related to cardiac function. Conclusion: NO, ET can be used as a good indicator to judge the severity of rheumatic mitral stenosis and the curative effect of PBMV and heart function.