Исследование сывороточного уровня асимметричного диметиларгинина у больных легочной гипертензией

Objective. Asymmetrical dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor. Increased level ADMA may contribute to endothelial dysfunction in patients with pulmonary hypertension (PH). The aim of the study was to assess the possible link between ADMA and basic determinants of PH severity. Design and methods. We examined 56 patients with PH (mean age 42,8 ± 14,5 years, 19 males): idiopathic pulmonary arterial hypertension was diagnosed in 32 subjects, 7 subjects had corrected congenital heart disease, 7 subjects had scleroderma, and 11 — inoperable chronic thromboembolic pulmonary hypertension, and 12 healthy subjects formed control group (41,8 ± 10,3 years, 3 males). Serum ADMA by ELISA method, serum NT pro-BNP (Elecsys) and uric acid levels were determined. Echocardiography, 6-minute walking test (6MWT), right heart catheterization and cardiopulmonary exercise testing (CPX) were performed. Results. The symptoms of II functional class (FC) WHO were present in 23 % patients, III FC — in 59 % patients and IV FC — in 13 % patients, 6MWT was decreased (362 ± 97 m) and NT-proBNP level was elevated (1833 ± 2176 pg/ml). Serum ADMA level in patients with PH were elevated in comparison with healthy controls (0,68 ± 0,25 vs 0,35 ± 0,12 µmol/l? p < 0,05). ADMA levels correlated with such prognostic markers as NT-proBNP (r = 0,44? p = 0,0008), mean right atrium pressure (r = 0,31? p < 0,05) and stroke volume LV (r = -0,34? p = 0,01). Serum ADMA was negatively correlated with 6MWT distance (r = -0,37? p = 0,004), work load by CPX (r = -0,42? p = 0,02). Conclusions. Serum ADMA level is elevated in patients with PH and correlates with prognostic markers. Also ADMA level predicts exercise intolerance. We assume that ADMA is a marker of endothelial dysfunction, and could be used for the assessment of PH severity.