摘要
目的观察先天性心脏病(CHD)介入封堵术前后血浆血管紧张素Ⅱ(AngⅡ)和血清一氧化氮(NO)水平的变化,探讨其在CHD并肺动脉高压(PH)中的作用及其意义。方法选取90例CHD患儿。均经体检、辅助检查及心脏彩色B超确诊。其中单纯房间隔缺损40例,单纯室间隔缺损30例,单纯动脉导管未闭20例。依据心导管测压,将90例CHD患儿分为3组:中重度PH组(肺动脉收缩压>6.66kPa)30例和轻度PH组(3.99kPa<肺动脉收缩压<6.66kPa)30例、无PH组(肺动脉收缩压<3.99kPa)30例。3个亚组的年龄及性别无统计学差异。分别采用放射免疫法和硝酸还原酶法测定各组术前、术后24h、术后1、3、6及12个月血浆AngⅡ及血清NO水平。另选取年龄及性别与之相匹配的健康体检儿童30例作为健康对照组,用同样方法检测其血浆AngⅡ及血清NO水平。结果介入封堵术前,CHD并PH组患儿血浆AngⅡ水平明显高于CHD无PH组(Pa<0.01);CHD并PH组患儿血清NO水平均明显低于CHD无PH组(Pa<0.01)。CHD患儿介入封堵术24h后,血浆AngⅡ逐渐下降,至12个月下降接近正常水平;CHD患儿介入封堵术24h后,血清NO开始逐渐上升,至12个月上升接近正常水平。AngⅡ与肺动脉收缩压呈显著正相关(r=0.811P<0.01);NO与肺动脉收缩压呈负相关(r=-0.421P<0.05)。结论AngⅡ及NO可能参与CHD的发生、发展过程;血浆AngⅡ及血清NO水平可作为判定其CHD患儿程度的参考指标之一。
Objective To observe the changes of angiotensin Ⅱ （ Ang Ⅱ） and nitrogen monoxidum （NO） in children with congenital heart diseases（CHD） pre -and post- interventional therapy, and explore their roles in C HD with pulmonary hypertension（PH）. Methods Ninety children with CHD were finally diagnosed by medical examination, auxiliary examination and color B - supersonic wave for heart. A- mong the total,40 cases were purely atrial septal defect,30 cases were purely interventricular septal defect,and 20 cases were purely patent ductus arteriosus. Ninety cases of CDH were divided into 3 groups by measuring pressure with cardiac catheter： 30 cases of moderate - severe degree pulmonary artery hypertension group （pulmonary arterial systolic pressure 〉 6.66 kPa） ,30 cases of light degree pulmonary artery hypertension group （3.99 kPa 〈 pulmonary arterial systolic pressure 〈 6.66 kPa）, and 30 cases of non - pulmonary artery hypertension group （pulmonary arterial systolic pressure 〈 3.99 kPa）. Three subset had no statistical difference in age and sex. Plasma AngⅡ and serum NO levels were detected by radioimmunoassay and nitrate reductase 24 hours before and after the operation therapy,after 1,3,6 and 12 months after interventional therapy in 90 children with CHD. Another 30 cases healthy children were selected as control group. Results Plasma Ang Ⅱ concentrations in moderate or severe PH group and slight PH group were significantly higher than those of normal pressure group（ Pa 〈 0.01 ） ; Serum NO concentrations in moderate or severe PH group and slight pulmonary hypertension group were significantly lower than that of normal pressure group（Pa〈 0.01 ）. In all 3 group,the plasma Ang Ⅱ concentration began to decrease at 24 hours after interventional therapy, and at 12 months its concentration approached to the normal level;the serum NO concentration began to increase at 24 hours after interventional therapy,and at 12 months its concentration approached to the normal level. And plasma Ang Ⅱ and serum NO concentration had a negative linear correlation with PH （r=0.811 P〈0.01;r= -0.421 P 〈0.05）. Conclusion AngⅡand NO may play an important role in the pathogenesis of CHD.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第10期794-796,共3页
Journal of Applied Clinical Pediatrics
基金
广西壮族自治区科技攻关项目资助(桂科攻0472002-30)
关键词
先天性心脏病
介入封堵术
肺动脉高压
血管紧张素Ⅱ
一氧化氮
congenital heart disease
interventional therapy
pulmonary hypertension
angiotensin Ⅱ
nitrogen monoxidum
作者简介
王新卫，男，主治医师，学士学位，研究方向为心血管疾病。
