二尖瓣狭窄患者经皮经静脉二尖瓣交界分离术前、后血浆β-内啡肽水平的变化

Changes of plasma beta-endorphin levels before and after percutaneous transvenous mitral commissurotomy in patients with mitral stenosis.

作者信息

Yin R, Zhu S, Zhao D, Toa X, Zeng Z, Xia S

机构信息

Institute of Cardiovascular Diseases, Guangxi Medical University, Nanning.

出版信息

Chin Med J (Engl). 1995 Nov;108(11):812-9.

PMID:8585972

Abstract

To clarify the contribution of left atrial pressure to the secretion of beta-endorphin, we have investigated the relation between plasma beta-endorphin levels and hemodynamic changes in 35 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, plasma beta-endorphin levels obtained from the antecubital vein (28.91 +/- 5.59 pg/ml) and from the femoral vein (28.20 +/- 5.44 pg/ml) in the patients with mitral stenosis were significantly higher than those obtained from the antecubital vein in the healthy volunteers (22.59 +/- 3.86 pg/ml, n = 34, P < 0.001 for each). The levels of beta-endorphin in the femoral vein correlated well with the mean left atrial pressure (r = 0.777, P < 0.001) and the mean right atrial pressure (r = 0.450, P < 0.01) before the procedure. The antecubital venous levels of beta-endorphin in patients in New York Heart Association functional Classes II (26.45 +/- 5.39 pg/ml, n = 20) and III (32.20 +/- 4.02 pg/ml, n = 15) were significantly higher than those in control subjects (P < 0.005 and P < 0.001, respectively). The differences between Classes II and III were significant (P < 0.001). The plasma levels of beta-endorphin in the patients complicated with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm (33.31 +/- 3.22 pg/ml, n = 13 vs 26.32 +/- 5.07 pg/ml, n = 22, P < 0.001). In ten to fifteen minutes after commissurotomy, plasma levels of beta-endorphin in the femoral vein significantly increased from 28.20 +/- 5.44 to 33.14 +/- 5.72 pg/ml (P < 0.001). In seventy-two hours after the procedure, plasma beta-endorphin levels in the antecubital vein fell to 24.37 +/- 2.59 pg/ml (P < 0.001 vs before PTMC and P < 0.05 vs control subjects). Plasma beta-endorphin levels in the patients with atrial fibrillation (26.62 +/- 2.36 pg/ml, P < 0.001 vs before PTMC and P < 0.002 vs control subjects) were still higher (P < 0.001) than those in patients with normal sinus rhythm (23.05 +/- 1.65 pg/ml, P < 0.001 vs before PTMC and P > 0.50 vs control subjects. There was a significant correlation between the levels of beta-endorphin in the antecubital vein and heart rate (r = 0.502, P < 0.001), mean transmitral pressure gradient (r = 0.543, P < 0.001) or mitral valve area (r = -0.710, P < 0.001) before and 72 hours after the procedure.

摘要

为阐明左心房压力对β-内啡肽分泌的作用，我们研究了35例接受经皮经静脉二尖瓣交界切开术（PTMC）的二尖瓣狭窄患者血浆β-内啡肽水平与血流动力学变化之间的关系。在PTMC前，二尖瓣狭窄患者肘前静脉（28.91±5.59 pg/ml）和股静脉（28.20±5.44 pg/ml）的血浆β-内啡肽水平显著高于健康志愿者肘前静脉的水平（22.59±3.86 pg/ml，n = 34，每组P < 0.001）。术前股静脉中的β-内啡肽水平与平均左心房压力（r = 0.777，P < 0.001）和平均右心房压力（r = 0.450，P < 0.01）密切相关。纽约心脏协会心功能II级（26.45±5.39 pg/ml，n = 20）和III级（32.20±4.02 pg/ml，n = 15）患者的肘前静脉β-内啡肽水平显著高于对照组（分别为P < 0.005和P < 0.001）。II级和III级之间的差异具有显著性（P < 0.001）。合并心房颤动患者的血浆β-内啡肽水平也显著高于窦性心律正常的患者（33.31±3.22 pg/ml，n = 13 vs 26.32±5.07 pg/ml，n = 22，P < 0.001）。交界切开术后10至15分钟，股静脉中血浆β-内啡肽水平从28.20±5.44显著升高至33.14±5.72 pg/ml（P < 0.001）。术后72小时，肘前静脉血浆β-内啡肽水平降至24.37±2.59 pg/ml（与PTMC前相比P < 0.001，与对照组相比P < 0.05）。心房颤动患者的血浆β-内啡肽水平（26.62±2.36 pg/ml，与PTMC前相比P < 0.001，与对照组相比P < 0.002）仍高于窦性心律正常的患者（23.05±1.65 pg/ml，与PTMC前相比P < 0.001，与对照组相比P > 0.50）。术前和术后72小时，肘前静脉中β-内啡肽水平与心率（r = 0.502，P < 0.001）、平均跨二尖瓣压力梯度（r = 0.543，P < 0.001）或二尖瓣面积（r = -0.710，P < 0.001）之间存在显著相关性。