Establishment of nitric oxide measurement in exhaled air and its clinical application.

本研究旨在建立人体呼出空气中一氧化氮(NO)的测定方法，并评价充血性心力衰竭(CHF)、高血压(HT)、高胆固醇血症(HL)、糖尿病(DM)、肺部疾病、慢性肾小球肾炎(CGN)和慢性肾功能衰竭(CRF)患者在运动时静息状态下肺组织内源性NO的生成是否受到异常调节。用石灰-格里斯法测定血浆中亚硝酸盐和硝酸盐(NOX)浓度作为全身NO产生的指标。1)CHF患者呼出的NO浓度和产量均高于对照组。运动使对照组的NO产量增加约3倍，但患者的增幅较小。这些发现表明，NO产生的异常调节可能导致运动诱导的血管扩张III心衰。2)高血压、HL和DM患者在输出CO…中呼出的NO浓度水平相似。与休息时的正常对照组相比有更多的改善。尽管运动增加了两组患者的NO排出量，但这些患者的增加幅度低于正常水平。在运动过程中，正常人的血浆NOX浓度升高，但在HT型患者中没有。这些发现表明，运动引起的NO产生的增加在这些患者中是受损的，这很可能是剪切力增加的结果。3)特发性肺炎和胶原病等肺部疾病患者的呼出NO浓度在输出中较高。提示胶原病矿物性炎症患者肺组织内源性NO生成增加，可能在其中起一定的病理生理作用。4)CGN患者(n=21)呼出的NO浓度和排出量均高于对照组。患者的血浆NOX浓度也显著高于对照组。在CGN患者中，呼出的NO输出量与肌酐清除量呈负相关。这些结果提示慢性肾小球肾炎患者内源性NO生成增加，可能在这些患者中起重要的病理生理作用。5)慢性肾功能衰竭患者呼出的NO浓度和产量以及血浆NOx浓度均高于正常对照组。这些值在血液透析患者和持续非卧床腹膜透析患者之间没有差别。呼出的NO的增加与循环中细胞因子的同时增加表明，在这些患者中，NO合成酶似乎被显着诱导。尿毒症患者内源性NO生成增加可能具有声学病理生理作用。较少

This study was performed to establish nitric oxide(NO) measurement iii the exhaled air in humans and to assess whether endogenous NO production of the lungs is abnormally regulated at rest amid during exercise in patients with various kinds of diseases such as congestive heart failure (CHF), hypertension (HT), hypercholesteremia (HL), diabetes mellitus (DM), lung diseases, chronic glomerular nephritis (CGN), and chronic renal failure (CRF). Plasma concentrations or nitrite plus nitrate (NOX) were measured by lime Griess method as indicators of systemic NO production.1) Patients with CHF (n=14) had higher exhaled NO concentration and output than controls. Exercise increased NO output about 3 times in controls, but the increase was smaller in the patients. These findings suggest that abnormal regulation of NO production may cause the attenuated exercise-induced vasodilation iii heart failure.2) Patients with HT, HL, and DM had the similar levels of exhaled NO concentration amid output co … More mpared with normal controls at rest. Although exercise increased NO output in both groups, the increase was less in these patients than was normals. Plasma NOX concentrations in the normals increased during exercise, but not in patients with HT.These findings suggested that exercise-induced increase of NO production, most likely as a consequence of increased shear stress, was impaired in these patients.3) Patients with lung diseases such as idiopathic pneumonitis and collagen diseases, had a higher exhaled NO concentration amid output. These results suggest that endogenous NO production is increased in the lungs of patients with mining imflamation of collagen diseases, and it may play some pathophysiological roles in these patients.4) Patients with CGN (n=21) exhaled higher concentrations of NO and output than did controls. Plasma NOX concentrations were also significantly greater in the patients than in the controls. In patients with CGN, exhaled NO output correlated negatively with creatinine clearance. These findings suggested that endogenous NO production is increased in patients with CGN.Increased endogenous NO production may play sonic pathophysiological role in these patients.5) Patients with CRE (n=40) had a higher exhaled NO concentration and output, and a higher plasma NOX concentration than did controls. These values did not differ between patients on hemodialysis amid those on continuous ambulatory peritoneal dialysis. The increase in exhaled NO with the simultaneous increase in circulating cytokines suggests that NO synthase seems to be induced significantly in these patients. increased endogenous NO production may have sonic pathophysiological role in uremic patients. Less