Serum apelin as a novel non-invasive marker for subclinical cardiopulmonary complications in children and adolescents with sickle cell disease.

BACKGROUND: Cardiovascular involvement represents a leading cause of mortality and morbidity in sickle cell disease (SCD). Apelin is a peptide involved in the regulation of cardiovascular function. AIM: To determine serum apelin among 40 children and adolescents with SCD compared with 40 healthy controls and assess its relation to markers of hemolysis, iron overload as well as cardiopulmonary complications. METHODS: SCD patients, in steady state and asymptomatic for heart disease, were studied stressing on hydroxyurea/chelation therapy, hematological profile, serum ferritin and apelin levels. Full echocardiographic study including assessment of biventricular systolic function and pulmonary artery pressure was done. RESULTS: Apelin levels were significantly lower in SCD patients compared with controls (P<0.001). Cardiopulmonary complications were encountered in 30% of patients. Apelin was significantly decreased among patients with cardiopulmonary disease (P=0.006) whether those at risk of pulmonary hypertension (P=0.018) or patients with heart disease (P=0.043). Hydroxyurea-treated patients had higher apelin levels than untreated ones (P=0.001). Apelin was negatively correlated to lactate dehydrogenase, indirect bilirubin, serum ferritin, end systolic diameter, tricuspid regurgitant jet velocity, right ventricle systolic pressure, pulmonary vascular resistance and tissue Doppler imaging S wave. Apelin cutoff value of 1650ng/L could significantly detect the presence of cardiopulmonary complications in SCD with 90.9% sensitivity and 72.4% specificity. CONCLUSION: Apelin is a promising marker for screening of SCD patients at risk of cardiopulmonary disease because it is altered during the early subclinical stage of cardiac affection. A combination of apelin and echocardiography provides a reliable method to assess cardiopulmonary affection in young SCD patients.

Salvia miltiorrhiza injection on pulmonary heart disease: a systematic review and meta-analysis.

Cor pulmonale (pulmonary heart disease) is a chronic progressive complicated disease for which treatment needs to be sustained all the time, creating a great financial burden on individuals and society. In order to improve the life quality of cor pulmonale patients and decrease the dosage and quantity of the routine treatment, in China, TCM is often administered to patients with cor pulmonale. The results of many clinical trials have indicated that Salvia miltiorrhiza and complex Salvia miltiorrhiza injection may be an alternative medicine for cor pulmonale. With the purpose to prove whether Salvia miltiorrhiza and complex Salvia miltiorrhiza benefit the cor pulmonale patients, respectively, we carried out a systematic review to evaluate the efficacy and safety of Salvia miltiorrhiza and complex Salvia miltiorrhiza injection in cor pulmonale patients. Overall, 2,715 patients were identified from 35 randomized controlled trials. The meta-analysis used I(2) test for heterogeneity and chose random or fixed model according to heterogeneity of included studies. Clinical outcomes were evaluated by total effectiveness rate, partial pressure of oxygen ( PaO 2) and carbon dioxide ( PaCO 2), hemorheology, mPAP and adverse effects. Compared with routine medicine treatment alone, routine medicine treatment plus Salvia miltiorrhiza or complex Salvia miltiorrhiza injection showed better outcomes: A significantly higher clinical effectiveness rate ratio (p < 0.001), increase in PaO 2 (p < 0.001) and decrease in PaCO 2 (p < 0.001), improvement in hemorheology (p < 0.001), and alleviation in mPAP (p < 0.05). There is no obvious adverse effect reported. In summary, there are some evidences suggesting that Salvia miltiorrhiza or complex Salvia miltiorrhiza injection are active in cor pulmonale, however, the results were limited by the methodological flaws of the included studies. Long-term and high quality clinical trials are needed to provide more conclusive evidence for the future use of Salvia miltiorrhiza injection.

[The influence shuxuetong on the membrane viscoelasticity of erythrocyte taken from patients with chronic pulmonary heart disease].

The present paper was aimed to explore the effect of Shuxuetong on the membrane viscoelasticity of erythrocyte taken from the acute phase patients suffering from chronic pulmonary heart disease. The membrane viscoelasticity of erythrocyte was taken from the acute phase patients suffering from chronic pulmonary heart disease. The changes of membrane viscoelasticity of erythrocyte after treated with shuxuetong were detected by micropipette aspiration technique. The results showed that the Shuxuetong of certain concentration could cause the decrease of membrane elastic modulus and viscous coefficients in acute phase patients suffering from chronic pulmonary heart disease. The study offers experimental evidences that the comprehensive treatment of pulmonary heart disease should involve the drug or measure to improve the erythrocyte deformability.

Effects of huang qi wu wu decoction on plasma proteins in 70 cases of chronic pulmonary heart disease.

Simple immune agar diffusion test was used to assay the contents of 12 plasma proteins in 70 cases of chronic pulmonary heart disease treated by Huang Qi Wu Wu Decoction ([symbol: see text]), with the other 70 cases who were not given Huang Qi Wu Wu Decoction as the control group. The total clinical effective rate in the treatment group was 90.0%, while that in the control group was 75.7%, with a statistically significant difference between the two groups (P < 0.05). In the treatment group, the levels of prealbumin, transferrin and fibronectin elevated obviously after treatment, and the contents of C-reactive protein, ceruloplasmin, haptoglobin, alpha 1-antitrypsin and alpha 1-acid glycoprotein decreased markedly (P < 0.01). In the control group, only the levels of ceruloplasmin and C-reactive protein decreased significantly (P < 0.05). It is shown that Huang Qi Wu Wu Decoction may enhance the therapeutic effects for pulmonary heart disease, regulate the metabolism of plasma proteins, and improve the life quality of the patients.

[Influence of safflower injection on hemorheology of patients of chronic cor pulmonale during acute attack].

OBJECTIVE: To study the effect of safflower injection (SI) on hemorheology and fibrinolytic system in treating patients of chronic cor pulmonale during acute attack. METHODS: Sixty patients were divided into two groups, 30 in each group. Both groups were treated with conventional therapy including anti-inflammatory, relieving cough and reducing sputum, cardial, diuretic and continuous low-flow oxygen inhalation. For the SI group, additional two courses of SI injection was given intravenously for 10 days as one course with an interval of 5 days between courses. The clinical therapeutic effect in the two groups and effect of treatment on hemorheology and fibrinolytic function were observed. RESULTS: The total effective rate in the SI group was 86.7% and that in the control group was 63.3%, the difference between the two groups was significant (P < 0.05). After treatment, in the SI group, the high- and low-shear whole blood viscosity, plasma viscosity, erythrocyte agglutination index, hematocrit and fibrinogen lowered obviously, as compared with before treatment (P < 0.01 or P < 0.05), and the improvement in hemorrheologic property was better than that in the control group significantly (P < 0.05). The blood activities of anti-thrombin III, plasminogen and tectotype profibrinolytic activating factor were all higher than those in the control group (P < 0.05, P < 0.01). And SI showed more potent effect in improving anti-coagulation and fibrinolytic function of patients than that of the control (P < 0.05). CONCLUSION: SI is an effective drug for treatment of hypercoagulability status in acute stage of chronic cor pulmonale, and is worthy of clinical application.

[Effects of ligustrazine on plasma platelet aggregation rate, thromboxane B2, 6-keto-prostaglandin F1 alpha and von Willebrand's factor in patients with acute onset of cor pulmonale].

OBJECTIVE: To study the effect on large dose of Ligustrazine on the function of platelet and endothelial cells of patients with acute onset of cor pulmonale. METHODS: Platelet aggregation rate (PAR), thromboxane B2 (TXB2), 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), von Willebrand's factor (vWF), PaO2 and PaCO2 were assayed in 30 patients with acute onset of cor pulmonale and 26 cases of control before and after treatment of large dose of Ligustrazine. RESULTS: PAR, vWF, TXB2, TXB2/6-keto-PGF1 alpha and PaCO2 decreased (P < 0.05, P < 0.01), and 6-keto-PGF1 alpha, PaO2, SaO2 increased (P < 0.01) after treatment of Ligustrazine, and only PaCO2 decreased in control. CONCLUSION: Ligustrazine had the function of antiplatelet and protecting the endothelial cells. Large dose (800 mg/d) had no side-effects.

[Observation on TXB2 and 6-keto-PGF1 alpha in serum of patients with cor pulmonale].

To know the changes of TXA2 and PGI2 in serum of patients with cor pulmonale, the levels of their stable metabolites TXB2 and 6-keto-PGF1 alpha in serum were examined in 28 patients with cor pulmonale during alleviation, 29 patients with cor pulmonale during exacerbation before and after treatment and 10 healthy subjects. TXB2 and 6-keto-PGF1 alpha were 109.74 +/- 56.14 ng/L and 54.76 +/- 35.62 ng/L respectively in healthy subjects; TXB2/6-keto-PGF1 alpha = 2.004. The TXB2 level of patients with cor pulmonale at every stage was higher than that of healthy subjects (P < 0.05-0.01). Patients with cor pulmonale during exacerbation had the highest TXB2 level of 709.22 +/- 354.49 ng/L, which decreased to 408.24 +/- 289.41 ng/L (P < 0.05) after treatment with traditional Chinese medicine combined with western medicine and the decreased level as such was not significantly different from that during alleviation (333.14 +/- 324.14 ng/L). The 6-keto-PGF1 alpha level in patients with cor pulmonale at every stage was not significantly different from that of healthy subjects. Since TXB2 increased, the value TXB2/6-keto-PGF1 alpha of patients with cor pulmonale was greater than that of healthy subjects. It is most likely that chronic hypoxia and hypercapnia lead to prostaglandin release in the lung of patients with cor pulmonale; hypoxia and hypercapnia become more severe during exacerbation resulting from infection; which lead to increased prostaglandin release, then high TXB2 level ensue as the result. TXB2 decreases after amelioration of hypoxia during treatment. But the change of 6-keto-PGF1 alpha is not obvious.

[Effect of Salvia miltiorrhiza on lipid peroxidation antioxidant enzymes activity in patients with chronic cor pulmonale].

This paper studied the effect of Salvia miltiorrhiza (SM) on plasma lipid peroxidation (LPO), RBC superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) activity in patients with chronic cor pulmonale. 30 patients were randomly divided into two treatment groups (routine and SM). The four parameters have been measured in 22 healthy subjects as control and patients of two treatment groups. The results showed: (1) Before treatment both treatment groups had significantly higher LPO and SOD and markedly lower GSH-Px and CAT level than that of healthy control (P < 0.001) respectively. (2) After treatment in routine group the four parameters have normalized, P < 0.05. (3) Routine treatment was compared with SM treatment, except SOD, the other three parameters were significantly different between two treatment groups (P < 0.001). The increased levels of GSH-Px and CAT and the decreased LPO were significantly greater in SM group than routine treatment (P < 0.001). The above-mentioned results indicated patients with cor pulmonale in acute exacerbation their lipid peroxide reaction was enhanced, the antioxidant enzymes lost their balance. SM could attenuate markedly lipid peroxide reaction, adjust the imbalance of the three antioxidant enzymes, enhance body's defence capability against damage of active oxygen free radical induced lipid peroxidation.

[Comparison study of various traditional Chinese medicine therapy in acute phase of cor pulmonale].

This article is a retrospective summary of 419 cases of acute phase of cor pulmonale from 1978 to 1989. These patients were divided into 4 groups by various TCM therapy, as a part of whole treatment combining TCM with the western medicine. They were (1) clearing the lung heat and eliminating the phlegm; (2) clearing the lung heat, tonifying the Qi and activating the blood; (3) clearing the lung heat, tonifying the Qi and nourishing the Yin; (4) clearing the lung heat, nourishing the Yin, tonifying the Qi and activating the blood. Under a similar condition, comparing the effects of the 4 various therapies in clinical efficacy and blood gas analysis, the authors found that the 4th therapy was the best among the 4 groups. According to the relation of modern pharmacology study of each single therapy, the authors explored the principle of clearing the lung heat, nourishing the Yin, tonifying the Qi and activating the blood therapy. The authors held that the therapy is a better one to treat many pathological changes in acute phase of cor pulmonale.

[Effects of different administration of Salvia miltiorrhiza and heparin on antithrombin IIIAg, antithrombin III: A and alpha 2-macroglobulin in patients with cor pulmonale].

The effects of different administration of Salvia miltiorrhiza (SM) and heparin on ATIII and alpha 2-M in 102 patients with cor pulmonale were studied. The results showed that (1) the level of ATIII in patients was significantly lower than that in the controls (P less than 0.01). Heparin intravenous drip induced ATIII decreased; (2) the level of ATIII:A in patients with heparin vapour inhalation treatment was significantly higher than that with regular treatment and with heparin intravenous drip (P less than 0.05) and (P less than 0.005); (3) SM presents ATIII-like activity, after treatment with SM, the level of ATIII:A was significantly higher than that with heparin vapour inhalation, heparin intravenous drip and regular treatment (P less than 0.05-0.005), heparin may enhance the ATIII-like activity of SM; (4) the treatment combining SM intravenous drip with heparin vapour inhalation is an efficient therapy of anticoagulation on the patients with cor pulmonale. The level of alpha 2-M in each group did not reveal significant change.

Pulmonary vasodilator therapy for chronic obstructive pulmonary disease and cor pulmonale. Treatment with nifedipine, nitroglycerin, and oxygen.

The present study was undertaken to evaluate the short-term effects of nitroglycerin, nifedipine, and supplemental oxygen on hemodynamics and gas exchange in 11 patients in stable condition with chronic obstructive pulmonary disease and cor pulmonale. In general, both intravenous nitroglycerin and sublingual nifedipine significantly reduced the pulmonary vascular resistance index. For the group as a whole, nifedipine decreased the pulmonary vascular resistance index by significantly increasing the cardiac index, with minimal reductions in mean pulmonary arterial pressure. Conversely, nitroglycerin decreased the pulmonary vascular resistance index by markedly reducing the mean pulmonary arterial pressure but also decreased the cardiac index in some patients. Nitroglycerin also caused a significant decrease in mixed venous oxygen tension. Administration of oxygen did not cause any clinically significant improvement in resting hemodynamics following short-term administration. During the follow-up period, eight of 11 patients who were treated with pulmonary vasodilators in addition to long-term therapy with low-flow oxygen died within a mean of six months. This rate of survival was not significantly different than an age-matched and sex-matched control group with similar severity of disease who received only long-term therapy with low-flow oxygen. Based on these data, it seems unlikely that a substantial increase in survival will be obtained by combining pulmonary vasodilators with long-term oxygen therapy in patients with stable emphysema who have cor pulmonale and carbon dioxide retention.