The vascular endothelial cells released a highly unstable vasodilator substance which was named the endothelium derived relaxing factor.Endothelium –derived relaxing factor was later identified as nitric oxide.Current evidence suggests that reduced pulmonary endothelial NO release may be the mechanism underlying hypoxic pulmonary vasoconstriction.
The present study was carried out to evaluate the level of plasma nitric oxide in Cor-pulmonale of different causes either hypoxic (COPD+Cor-pulmonale)or obliterative (Bilharzial)
This study was conducted on eighty five persons of both gender with age ranged from 40to 70 years old. The study included three groups. Group I included 50 patients have COPD according to (GOLD 2003),and subdivided into group I-a was 25 patients have(COPD+Cor-pulmonale)and I-b was 25patients have COPD without Cor-pulmonale Group II included 10 patients have bilharzial Cor-pulmonale .Group III included 25 apparently healthy persons as a control group.
All persons were subjected to full history, clinical examination, complet blood picture, ESR, CRP, kidney and liver function, blood sugar, plain X-ray chest ,arterial blood gases analysis, ventilatory pulmonary function tests,electrocardiogram examination, Echocardiographic and doppler examination and estimation of total plasma nitrate and nitrate (plasma nitric oxide).Abdominal ultrasonography was done for patients of group II for diagnosis of portal hypertension.
Pulmonary function tests of the patients groups shows moderet to sever obstruction in group I (COPD),mild obstruction and restriction in group II(bilharzial Cor-pulmonale).
There was direct significant relation between FEV1 and plasma nitric oxide in group I-a and I-b (the reduction in FEV1 was associated with reduction in nitric oxide ,in group II there was insignificant relation.
Arterial blood gases of the studied groups shows significant hypoxemia in group I-a in comparring to I-b, and significant hypoxemia in group I-b in comparring to group II.there was mild hypoxemia in group II.
There was inverse significant relation between PaO2 and degree of pulmonary hypertension in group I-a (sPAP,mPAP)
Cor-pulmonale was present in group I-a and group II confirmed by ECG and echocardiography. The degree ofpulmonary hypertension in group II (bilharzial) was more than in group I-a (hypoxic).
Plasma nitric oxide was reduced in group I either I-a and I-b .The reduction in group I-a more than in I-b with significant difference.
There was no significant difference between nitric oxide in group II and the control.There was highly significant difference between group I-a and group II ,and there was significant difference between group I-b and group II.
Plasma nitric oxide have direct significant relation with PaO2 in COPD patients.
Nitric oxide have inverse and significant relation with the degree of pulmonary hypertension in group I-a (COPD+Cor-pulmonale) either ECG finding,radiological finding,and echcardiographic finding.
Nitric oxide have insignificant relation with the degree of pulmonary hypertension in group II (bilharzial Cor-pulmonale)
Nitric oxide was reduced significantly in (COPD +Cor-pulmonale) due to hypoxemia ,nitric oxide have no relation with the development of cor –pulmonale in bilharziasis
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