ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 28 of 67
УЖМБС 2020, 5(3): 215–221
Clinical Medicine

Markers of Endothelial Dysfunction among Patients with Pulmonary Hypertension on the Background of Chronic Obstructive Pulmonary Disease

Nikolaieva K. L.

Chronic obstructive pulmonary disease greatly affects the quality of life, significantly limiting the physical capabilities of people suffering from it. The prevalence of chronic obstructive pulmonary disease worldwide is about 7.6%, and it is one of the main causes of morbidity and mortality in today’s society. An urgent medical and social problem of our time is the development of pulmonary hypertension in patients with chronic obstructive pulmonary disease. According to modern concepts, endothelial dysfunction of the pulmonary vessels is an important link in the pathogenesis of pulmonary hypertension, which leads to an increase in the production of active vascular mediators, such as endothelin-1. Increased production of endothelin-1 on the one hand and a decrease in nitric oxide on the other one leads to a violation of the vasoactivity properties of the pulmonary vessels and their vasoconstriction. The purpose of the study was to determine the levels of markers of endothelial dysfunction among patients with pulmonary hypertension on the background of chronic obstructive pulmonary disease. Material and methods. The results of the study are based on data from a comprehensive survey of 170 patients aged 40 to 65 years with chronic obstructive pulmonary disease, 123 of whom had pulmonary hypertension and 47 ones had no pulmonary hypertension. Results and discussion. The median level of Endothelin-1 among pulmonary hypertension patients with chronic obstructive pulmonary disease was 3.17 [2.19; 4.14] fmol / ml and was significantly higher both against 1.78 [1.25; 2.18] fmol / ml in the group of chronic obstructive pulmonary disease patients without pulmonary hypertension (p <0.05), and 10.2 times higher than the level of 0.31 [0.19; 0.36] fmol/ml in the group of healthy individuals (p <0.05). The amount of nitrogen oxide metabolites (NO2+ NO3) was significantly lower by 15.8% in patients with pulmonary hypertension with chronic obstructive pulmonary disease – 19.00 [17.00; 21.00] mmol / l versus 22.00 [21.00; 23,00] mmol / l in the group of chronic obstructive pulmonary disease patients without pulmonary hypertension (p <0,05) and reliably lower by 37% compared to the group of healthy patients, where the level of this indicator was 26,00 [25,00; 28,00] mmol/l, (p <0,05). The level of Endothelin-1 was significantly higher in the chronic obstructive pulmonary disease stage III subgroup – 3.57 [2.56; 4.39] fmol / ml versus 2.08 [1.50; 2.83] fmol / ml in the t stage II subgroup a, respectively, (p <0.05). Correlation analysis revealed significant relationships between the following indicators: duration of chronic obstructive pulmonary disease and NO3 (R = -0.29, p = 0.001); duration of chronic obstructive pulmonary disease and NO2+ NO3 (R = -0.26, p = 0.003); mean pulmonary artery pressure and Endothelin-1 (R = + 0.70, p = 0.001); mean pulmonary artery pressure and NO2 (R = -0.59, p = 0.001); mean pulmonary artery pressure and NO2+ NO3 (R = -0.50, p = 0.001). Conclusion. Patients with chronic obstructive pulmonary disease experience endothelial dysfunction, characterized by an increase in endothelin-1 concentration and a decrease in metabolites of nitric oxide in blood plasma. When pulmonary hypertension occurs in patients with chronic obstructive pulmonary disease, there is a further increase in endothelin-1 levels in blood plasma. Increasing the degree of pulmonary hypertension increases endothelin-1 levels and decreases the amount of nitric oxide metabolites in the blood plasma.

Keywords: markers of endothelial dysfunction, pulmonary hypertension, chronic obstructive pulmonary disease, mean pulmonary artery pressure

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