急性肺栓塞溶栓治疗中ET-1和NO的动态变化及葛根素的干预作用

摘要

Objective To study the dynamic change of endothelin -1 ( ET - 1) and nitric oxide ( NO) during thrombolytic therapy in acute pulmonary thromhoembolism and to determine the effects of puerarin. Methods Twenty - one lapanese rabbits were randomly divided into sham operation group ( A group) , thrombolysis group( B group) . and thrombolysis + puerarin group ( C group) . Acute pulmonary embolism models of rabbits were established by injection of autologous blood clots through the right heart cathcters. Pulmonary arterial pressure was measured by heart catheterization. The contents of plasma ET - 1 and NO were surveyed before embolization,2h after embolization, 2h and 4h after thrombolysis. The structure of lung tissue was observed by histopaLhologic and electron microscopic investigations.Results Pulmonary arterial mean pressure ( mPAP) was decreased immediately at 1 hour after thromholysis both in R group and C group (P ＜0. 01 ) . mPAP in C group was significantly lower than those in B group begin at 1h after thrombolysis ( P ＜ 0. 05 ). The contents of plasma ET - 1 began to increase at 2h after embolization both in B group and C group ( P ＜ 0. 05 ,P ＜ 0. 01 ) . The content of NO began to decline at 2h after embolization ( P ＜ 0. 05 ,P ＜0.01 ) . At 2h and 4h after thrombolysis ,the content of ET - 1 was lower ( P ＜ 0. 05 , P ＜ 0. 01 ) and the content of NO was higher ( P ＜ 0. 05 , P ＜ 0. 01 ) in C group than those in B group. Histopathologic analysis showed the injuries of endotheliums and type Ⅱ alveolar cells in B group were more severe than those in C group. Conclusion Puerarin may effectively increase the content of plasma NO and reduce the content of plasma ET - 1 after thrompolytic therapy in acute pulmonary embolism , thus protect endothelial cell, which protects lung against reperfusion injury.%目的 研究急性肺栓塞溶栓治疗中内皮素-1(ET-1)和一氧化氮(NO)的动态变化及葛根素的干预作用.方法 日本大耳白兔21只,随机分为假手术组(A组)、溶栓组(B组)、溶栓+葛根素组(C组).自体血栓经右心导管注入,制备兔急性肺栓塞模型.心导管法监测肺动脉压,各组在栓塞前、栓塞后2h、溶栓后2h、4h检测血浆中ET-1和NO含量;光镜、电镜观察肺组织病理.结果 在溶栓开始后1h,B组和C组肺动脉平均压(mPAP)即显著下降(P<0.01),且C组mPAP明显低于B组(P<0.05);在栓塞后2h、溶栓后2h、4h,B组和C组血浆ET-1含量均明显高于栓塞前(P<0.05,P<0.01),而NO含量明显低于栓塞前(P<0.05,P<0.01);与B组同期比较,C组在溶栓后2h、4h血浆ET-1和NO含量分别有明显下降和升高(P<0 05,P<0.01).组织病理显示,C组肺组织结构破坏减轻,血管内皮细胞和肺泡Ⅱ型上皮细胞损伤较B组明显减轻.结论葛根素可有效提高急性肺栓塞溶栓后血浆中NO含量和减低ET-1含量,有内皮保护作用,对溶栓治疗后再灌注损伤有保护作用.