血管活性物质对大鼠低氧性肺血管结构重建作用的研究

目的：探讨内皮素-1（ET-1）、血管内皮生长因子（VEGF）在低氧性肺血管结构重建中的调节作用。方法：将2260m处的Wistar大鼠带到3417m的高度饲养24h,2周、3周后进行实验并和在当地捕捉到的高原鼠兔进行比较。取血,测定血液中的ET-1、VEGF的含量,然后取肺组织固定切片染色,40倍光镜下计数整个切片内的肺泡水平位上直径小于100μm的肌性动脉（AM）、部分肌性动脉（PAM）和非肌性动脉（NMA）的数目,分别计算它们各占肺小血管总数的百分比。左右心室室间隔分别称重．计算右室／左室＋室间隔。结果：高原鼠兔与缺氧不同时间大鼠VEGF及ET-1经组间方差分析均有显著差异（P〈0．01,随着缺氧时间的延长,大鼠MA及PMA的比例增加,NMA减少,RV／LV＋S逐渐增加（和高原鼠免比P〈0．01）,经组间方差分析亦有显著差异（P〈0．01）。结论：低氧环境下VEGF及ET-1共同参与了肺小血管的肌化过程,在低氧性肺动脉高压的发生发展中起到了重要作用,但在高原鼠兔体内仅具有维持组织器官发育和维持其正常功能的作用。     

慢性低氧性肺动脉高压大鼠肺组织肾上腺髓质素-2的变化

目的：研究新的小分子生物活性肽肾上腺髓质素-2（ADM2／IMD）及其受体在慢性低氧性肺动脉高压大鼠肺组织中的变化和可能的作用。方法：SD大鼠随机分成2组（n=10）：正常对照（NC）组和低氧四周（4H）组;放射免疫法测定血浆和肺组织ADM2／IMD和肾上腺素髓质素（ADM）蛋白水平;逆转录-多聚酶链反应（RT-PCR）法测定肺组织ADM2／IMD、ADM及其受体（CRLR,RAMP1,2,3）mRNA表达;免疫组化法测定ADM2／IMD在肺细小动脉的定位表达：结果：①4H组平均肺动脉压（mPAP）、右心室与左心室加室间隔重量比[RV／（LV＋S）]高于NC组（P均〈0．01）。②4H组血浆和肺组织匀浆ADM水平分别为NC组的2．3倍和3．2倍（P均〈0．01）,ADM2／IMD水平分别比NC组高89．6％和45．0％（P分别〈0．01、〈0．05）。③4H组肺组织ADM2／IMD与ADMmRNA表达高于NC组（P分别〈0．01、〈0．05）,CRLR和RAMP1mRNA表达显著低于NC组（P均〈0．01）,而RAMP2和RAMP3mRNA表达水平两组间差异无显著性。①ADM2／IMD主要在大鼠肺细小动脉内皮细胞及血管外膜表达。结论：ADM2／IMD与ADM相似,与大鼠慢性低氧性肺动脉高压病理过程密切相关;ADM2／IMD及其受体CRLR／RAMP1基因表达和／或蛋白合成、代谢的改变可能参与了大鼠慢性低氧性肺动脉高压的发生发展.     

NO和HIF-1α在大鼠低氧性肺动脉高压中的作用及相互关系

目的：探讨低氧诱导因子1α（HIF-1α）在慢性低氧高二氧化碳性大鼠肺动脉高压中的变化及其与一氧化氮（NO）的关系。方法：SD大鼠40只随机分为正常对照组（NC）、低氧高二氧化碳组（HH）、低氧高二氧化碳加L-精氨酸（L-Arg）脂质体组（HP）、低氧高二氧化碳加L-硝基-精氨酸甲酯（L-NAME）组（HM）。测定平均肺动脉压（mPAP）、右室／（左室＋室间隔）重量比[RV／（LV＋S）]、血浆和肺组织匀浆一氧化氮（NO）含量。免疫组织化学和原位杂交法检测肺细小动脉HIF-1α及HIF-1αmRNA、内皮结构型一氧化氮合酶（ecNCS）蛋白及其mRNA的表达。结果：①HH组mPAP、RV／（LV＋S）高于NC组（P〈0．05）,HP组低于HH组（P〈0．01）;HM组mPAP高于HH组（P〈0．05）,RV／（LV＋S）与HH组差异无显著性。②HH组血浆及肺组织匀浆NO含量低于NC组（P〈0．01）,HP组高于HH组（P〈0．01）;HM组血浆、肺组织匀浆NO含量与HH组差异无显著性。③HH组肺细小动脉HIF-1α蛋白及HIF-1αmRNA表达高于NC组（P〈0．01）,ecNOSmRNA的表达低于NC组（P〈0．01）;HP组肺细小动脉HIF-1α蛋白及HIF-1αmRNA表达低于HH（P〈0．01）,ecNOS蛋白和ecNOSmRNA的表达高于HH组（P〈0．01）;HM组肺细小动脉HIR-1α蛋白及mRNA表达高于HH组（P〈0．05）,ecNOS蛋白和mRNA的表达低于HH组（P〈0．05）。结论：HIF-1α参与了慢性低氧高二氧化碳性大鼠肺动脉高压的形成,NO可能部分通过影响HIF-1α的表达和／或活性而实现其肺血管保护效应。     

内源性硫化氢体系与低O2高CO2性肺动脉高压的相关性研究

目的：研究低O2高CO2性肺动脉高压（HHPH）时大鼠肺组织内硫化氢（H2S）体系变化的改变及相关性,并探讨其机制。方法：20只SD大鼠随机分为正常对照组（C组）和低O2高CO2组（HH组）（n=10）。监测其血流动力学变化,光镜观察肺细小动脉管壁面积／管总面积比值（WA／TA）,测右心室／左心室＋室间隔（RV／LV＋SP）比值。原位缺口末端标记法（TUNEL法）观测肺细小动脉凋亡情况,并计算凋亡指数（AI）,免疫组化检测肺细小动脉Bcl-2、Bax蛋白表达。敏感硫电极法测定血浆H2S含量及肺组织匀浆胱硫醚-γ-裂解酶（CSE）活性变化。RT-PCR法测定肺组织中CSE基因表达。结果：HH组肺平均动脉压（mPAP）、WA／TA、RV／LV＋SP明显高于C组（P〈0．05或P〈0．01）。与C组相比,HH组AI显著下降（P〈0．01）,Bcl-2表达加强,Bax减弱,Bax／Bcl-2比值上升（均P〈0．01）。血浆H2S含量、肺组织匀浆CSE活性、肺组织CSE基因表达水平HH组明显低于C组（P〈0．01）。血浆H2S、肺组织CSE活性、肺组织CSE mRNA相对含量与mPAP,Bcl-2／Bax比值均呈显著负相关,与AI呈显著正相关。结论：H2S／CSE体系与低O2高CO2性肺动脉高压关系密切,HHPH时H2S／CSE体系的明显受抑,可使Bcl-2／Bax比值升高,肺动脉平滑肌细胞凋亡减少,促进肺血管重建和肺动脉高压的形成。     

慢性低氧所致肺动脉高压对大鼠肺血管平滑肌细胞及成纤维细胞中蛋白激酶CβI的膜转位和蛋白表达量的影响

目的通过观察慢性低氧所致肺动脉高压对大鼠肺血管平滑肌细胞及成纤维细胞中蛋白激酶CBI（PKCβI）的膜转位和蛋白表达量的影响,初步探讨PKCpI在慢性低氧诱导大鼠肺动脉高压的发生、发展过程中所起的作用。方法建立慢性常压低氧肺动脉高压大鼠模型,将雄性SD大鼠随机分为正常对照组、低氧1d、3d、7d、14d和21d组,应用蛋白免疫印迹和免疫组化技术检测肺动脉高压形成过程中大鼠肺血管平滑肌细胞及成纤维细胞中PKCβI的膜转位和蛋白表达水平。结果（1）RVSP和RV／（LV＋S）比值较正常对照组明显增加（P〈0．05）,低氧后3d、7d、14d和21d后大鼠肺血管明显增厚;（2）大鼠肺血管平滑肌细胞和成纤维细胞均有PKCβI的表达,且低氧14d后PKCβI的蛋白表达量较正常对照组相比降低（P〈0．05）。结论PKCβI蛋白表达量的下调可能参与了慢性低氧诱导的大鼠肺动脉高压肺血管重塑的发生、发展过程。     

骨髓间充质干细胞移植对大鼠低氧性肺动脉高压的影响

目的：探讨骨髓间充质干细胞（MSCs）移植对大鼠低氧性肺动脉高压（HPH）的影响。方法：体外分离、培养、鉴定SD大鼠骨髓MSCs、绿色荧光蛋白腺病毒标记MSCs细胞。将健康雄性SD大鼠随机分为4组：正常对照组（NC组）8只、低氧性肺动脉高压组（HPH组）8只,低氧性肺动脉高压同时骨髓间充质干细胞移植组（MSCs组）24只,低氧性肺动脉高压同时携带血管内皮生长因子（VEGF）的MSCs移植组（VEGF＋MSCs组）24只。采用常压间歇低氧法建立大鼠肺动脉高压模型,干细胞转染并行干细胞移植。观察大鼠平均肺动脉压力（mPAP）,计算右心室肥厚指数（RVHI）,显微镜下观察各组大鼠肺小动脉形态结构改变,并在荧光显微镜下观察干细胞移植7d,14d,28d时腺病毒转染荧光标记的MSCs在肺小动脉分布及表现。结果：NC组28d时mPAP（mmHg）为15．5±1．5,而HPH组、MSCs组及MSCs＋VEGF组分另q为26．1±1．9、21．6±2．7及20．1±2．9,均明显高于NC组（P〈0．01）,但MSCs组及MSCs＋VEGF组较HPH组明显下降（P〈0．01）,MSCs组与MSCs＋VEGF组无明显差别。NC组28d时RVHI为0．28±0．02,而HPH组、MSCs组及MSCs＋VEGF组RVHI分别为0．43±0．07、0．34±0．03及0．35±0．01,均明显高于NC组（P〈0．01）,但MSCs组及MSCs＋VEGF组较HPH组明显下降（P〈0．05）,MSCs组与MSCs＋VEGF组无明显差别。HPH组28d时,肺小动脉管壁明显增厚,管腔明显狭窄、闭塞,内皮细胞不完整,而MSCs组血管壁较HPH组变薄,管腔通畅,内皮细胞完整性改善,MSC8组及MSCs＋VEGF组的表现改变不明显。结论：骨髓间充质干细胞移植可改善肺小动脉血管重塑,从而部分逆转HPH的进程;而将VEGF与MSCs联合移植并未提高单纯MSCs移植的作用。     

Intermedin/adrenomedullin 2及其受体在慢性低氧性肺动脉高压大鼠右心室的表达变化

本研究探讨了新发现的小分子生物活性肽intermedin／adrenomedullin 2（IMD／ADM2）及其受体在慢性低氧性肺动脉高压大鼠右心室中的变化和可能作用。用放射免疫分析法测定正常对照组和常压低氧4周组Sprague-Dawley大鼠血浆、右心室匀浆IMD／ADM2和肾上腺髓质素（adrenomednllin,ADM）蛋白水平;逆转录-多聚酶链反应法测定右心室IMD／ADM2、ADM及受体：降钙素受体样受体（calcitonin receptor-like receptor,CRLR）、受体活性修饰蛋白1,2,3（receptor activity modifying protein 1,2,3,RAMP1,RAMP2,RAMP3）mRNA表达。结果显示：低氧组平均肺动脉压、右心室与左心室加室间隔重量比[RV／（LV＋S）]显著高于对照组（均P〈0．01）;低氧组血浆和右心室组织匀浆ADM水平比对照组分别高1．26倍和1．68倍（P〈0．01）,IMD／ADM2水平则较对照组分别高0．90倍和1．19倍（P〈0．01）;与对照组相比,低氧组右心室IMD／ADM2、ADM mRNA表达均上调（P〈0．01）,RAMP2 mRNA表达增强（P〈0．05）,而两组间CRLR、RAMP1、RAMP3 mRNA的表达水平无显著性差异。结果表明,慢性低氧性肺动脉高压大鼠IMD／ADM2表达水平升高。     

尼氟灭酸在大鼠低氧高二氧化碳性肺血管收缩中的作用

目的：探讨氯离子通道阻断剂一尼氟灭酸（NFA）在大鼠低氧高二氧化碳性肺血管收缩（HHPV）中的作用。方法：采用大鼠HHPV模型,二、三级动脉环分别随机分4组（n=8）：常氧组（N组）、低氧高二氧化碳组（H组）、DMSO组（HD组）、尼氟灭酸组（NFA组）。在急性低氧高二氧化碳介质中,采用NFA分别孵育肺二、三级肺动脉环,按照低氧高二氧化碳反应性测定的方法测定其二、三级肺动脉血管环张力的变化,并观察NFA对HHPV的影响。结果：①H组二、三级肺动脉均呈现双向性收缩变化（I期快速收缩、快速舒张;II期持续性收缩）与N组相比有显著性差异（P〈0．05,P〈0．01）;②NFA组二、三级肺动脉环的低氧高二氧化碳性血管收缩作用明显减弱,尤其是Ⅱ期的持续收缩,与HD组相比有显著性差异（P〈0．05,P〈0．01）。结论：氯离子通道阻断剂一尼氟灭酸可减轻大鼠二、三级肺动脉环的张力变化率（尤其是Ⅱ期的持续性收缩）,从而发挥拮抗HHPV的作用。     

NO前体对高肺血流时肺动脉胱硫醚-γ-裂解酶基因表达的调节作用

目的：研究一氧化氮（NO）前体L-精氨酸（L—Arg）对高肺血流时肺动脉胱硫醚-γ-裂解酶（内源性硫化氢生成酶）的调节作用,以探讨NO体系对高肺血流肺动脉高压及肺血管结构重建调节作用的机制。方法：30只雄性SD大鼠随机分为对照组,分流组和分流＋L—Arg组。对后两组大鼠行腹主动脉-下腔静脉分流术。观察术后11周大鼠肺动脉平均压（mPAP）、右心室肥厚和肺动脉相对中膜面积的改变,用竞争逆转录聚合酶链反应（RT-PCR）对肺组织CSEmRNA表达进行定量分析,同时用化学法测定肺组织硫化氢产出率。结果：分流组大鼠mPAP及肺动脉相对中膜面积明显高于对照组（P〈0．01）,而分流＋L—Arg组大鼠mPAP及肺动脉相对中膜面积明显低于分流组（P〈0．01）。分流组CSEmRNA表达与对照组相比明显降低（P〈0．01）,而分流组＋L—Arg组CSEmRNA表达又明显高于分流组（P〈0．05）：分流组大鼠肺组织硫化氢产出率明显低于对照组（P〈0．01）,而分流组＋L—Arg组大鼠肺组织硫化氢产出率及血浆硫化氢含量明显高于分流组（P〈0．01）。结论：高肺血流可致肺动脉CSEmRNA下调,外源性NO能够缓解CSEmRNA的改变,从而对高肺血流所致肺血管结构重建和肺动脉高压起调节作用。     

姜黄素对慢性低氧高二氧化碳大鼠肺动脉高压及肺动脉管壁胶原的影响

目的：研究姜黄素对慢性低氧高二氧化碳大鼠肺动脉压力及肺动脉管壁Ⅰ型胶原的影响。方法：36只SD大鼠随机分为正常对照组（NC组）,低O2高CO2 4周组（HH组）,低O2高CO2 4周＋姜黄素组（HC组）,采用免疫组化、图像分析等方法观察姜黄素对慢性低O2高CO2大鼠肺动脉压力、肺细小动脉显微和超微结构及肺动脉管壁Ⅰ型胶原的影响。结果：①血流动力学检测显示HH组mPAP明显高于NC组（P〈0．01）,HC组mPAP明显低于HH组（P〈0．01）,三组间mCAP无明显差异（P〉0．05）;②光镜下,肺细小动脉管壁面积／管总面积比值（WA／TA）、肺细小动脉中膜平滑肌细胞核密度（SMC）、肺细小动脉中膜厚度（PAMT）HH组较NC组明显增高（均P〈0．01）,HC组WA／TA、SMC和PAMT较HH组明显降低（均P〈0．01）;③电镜下,HH组肺细小动脉中膜平滑肌细胞增生,面积增大,染色质增多,外膜胶原纤维密集,HC组大鼠肺细小动脉内皮细胞结构基本正常,胶原少见,中膜平滑肌细胞和外膜胶原纤维增生较HH组明显为轻;④免疫组化法发现肺细小动脉Ⅰ型胶原平均吸光度值HH组明显高于Nc组（P〈0．01）,HC组明显低于HH组（P〈0．01）。结论：姜黄素具有降低慢性低O2高CO2性肺动脉高压、改善肺血管重建及抑制肺动脉管壁Ⅰ型胶原沉积的作用。     

Functional adaptation and remodeling of pulmonary artery in flow-induced pulmonary hypertension

Patients with left-to-right shunt congenital heart disease may develop pulmonary hypertension. Perioperative mortality of these patients is high due to abnormal vasoreactivity of the pulmonary artery (PA). We studied the changes in the PA induced by high pulmonary blood flow in rats with aortocaval fistula. Eight weeks after surgery, morphological changes of the PA were studied and vasomotor function was assessed by isometric force recording. Expression of endothelial nitric oxide (NO) synthase (eNOS), VEGF, and cyclooxygenase-2 (COX-2) proteins and levels of cGMP in the PA were analyzed. Rats with high pulmonary blood flow developed pulmonary hypertension, medial thickening, and increasing of internal elastic lamina and basement membrane in the PA. When compared with sham-operated animals, rats with fistula had significantly increased contractions in the PA, whereas relaxations to acetylcholine and NO donor were reduced. Concentrations of cGMP were reduced in the PA of rats with pulmonary hypertension (18.4 +/- 3.3 vs. 9.4 +/- 1.7 pmol/mg protein; P = 0.04). The altered vasomotor function was normalized by treatment with indomethacin. The PA of rats with fistula expressed higher levels of eNOS, phosphorylated eNOS, and COX-2. Sustained high PA blood flow in rats causes pulmonary hypertension that is morphologically and functionally identical with patients with flow-induced pulmonary hypertension. Abnormal vasomotor function of the PA in these animals appears to be mediated by reduced availability and the biological effect of endogenous NO and the high production of vasoconstrictor prostanoids. Increased eNOS and phosphorylated eNOS are most likely the adaptive changes in response to an increase in PA pressure secondary to high blood flow.     

The outcome of pulmonary hypertension and its association with pulmonary artery dilatation

Background

Pulmonary artery (PA) dilatation is often seen in pulmonary hypertension (PH) and is considered a long-term consequence of elevated pressure. The PA dilates over time and therefore may reflect disease severity and duration. Survival is related to the stage of the disease at the time of diagnosis and therefore PA diameter might be used to predict prognosis. This study evaluates the outcome of patients with pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH) and investigates whether PA diameter at the time of diagnosis is associated with mortality.

Methods

Patients visiting an outpatient clinic of a tertiary centre between 2004 and 2018 with a cardiac catheterisation confirmed diagnosis of PAH or CTEPH and a CT scan available for PA diameter measurement were included. PA diameter and established predictors of survival were collected (New York Heart Association (NYHA) class, N‑terminal pro-brain natriuretic peptide (NT-proBNP) level and 6‑min walking distance (6MWD)).

Results

In total 217 patients were included (69% female, 71% NYHA class ≥III). During a median follow-up of 50 (22–92) months, 54% of the patients died. Overall survival was 87% at 1 year, 70% at 3 years and 58% at 5 years. The mean PA diameter was 34.2 ± 6.2 mm and was not significantly different among all the diagnosis groups. We found a weak correlation between PA diameter and mean PA pressure ( r = 0.23, p < 0.001). Male sex, higher age, shorter 6MWD and higher NT-proBNP level were independently associated with mortality, but PA diameter was not.

Conclusion

The prognosis of PAH and CTEPH is still poor. Known predictors of survival were confirmed, but PA diameter at diagnosis was not associated with survival in PAH or CTEPH patients.

     

Bicarbonate-dependent superoxide release and pulmonary artery tone

Pulmonary vasoconstriction is influenced by inactivation of nitric oxide (NO) with extracellular superoxide (O2-*). Because the short-lived O2-* anion cannot diffuse across plasma membranes, its release from vascular cells requires specialized mechanisms that have not been well delineated in the pulmonary circulation. We have shown that the bicarbonate (HCO3-)-chloride anion exchange protein (AE2) expressed in the lung also exchanges O2-* for HCO3-. Thus we determined whether O2-* release involved in pulmonary vascular tone depends on extracellular HCO3-. We assessed endothelium-dependent vascular reactivity and O2-* release in the presence or absence of HCO3- in pulmonary artery (PA) rings isolated from normal rats and those exposed to hypoxia for 3 days. Lack of extracellular HCO3- in normal PA rings significantly attenuated endothelial O2-* release, opposed hypoxic vasoconstriction, and enhanced acetylcholine-mediated vasodilation. Release of O2-* was also inhibited by an AE2 inhibitor (SITS) and abolished in normoxia by an NO synthase inhibitor (NG-nitro-L-arginine methyl ester). In contrast, hypoxia increased PA AE2 protein expression and O2-* release; the latter was not affected by NG-nitro-l-arginine methyl ester or other inhibitors of enzymatic O2-* generation. Enhanced O2-* release by uncoupling NO synthase with geldanamycin was attenuated by hypoxia or by HCO3- elimination. These results indicate that O2-* produced by endothelial NOS in normoxia and unidentified sources in hypoxia regulate pulmonary vascular tone via AE2.     

Normal nomogram of the pulmonary artery

With the aim to establish quantitative characteristics of the pulmonary artery in order to use them in planning operations on congenital heart diseases, the data of morphometric investigations on the pulmonary artery has been studied in 83 hearts of newborns, children and mature persons died from causes not connected with any cardiovascular disorders. The regression equations are calculated; they reflect certain dependence between the quantitative characteristics of the pulmonary artery and the area of the body surface.