血浆血管内皮生长因子和转化生长因子β1的含量与先天性心脏病合并重度肺动脉高压患儿手术前、后肺动脉压力的关系

Relationship between level of serum vascular endothelial growth factor, transforming growth factor β1 and pulmonary artery pressure in children with congenital heart disease before and after severe pulmonary hypertension surgery

目的 观察先天性心脏病合并重度肺动脉高压患儿手术前后血浆血管内皮生长因子、转化生长因子β1含量的变化,并探讨与肺动脉压力的关系.方法 选择2014年6月至2015年1月我院收治的先天性心脏病患者60例,其中左向右分流型先天性心脏病合并重度肺动脉高压30例,无合并肺动脉高压30例.所有患儿均在手术前、术后24h、术后7d及术后30 d检测患儿血浆血管内皮生长因子、转化生长因子β1的含量;并行超声心动图估测肺动脉平均压（PAMP）.结果 重度肺动脉高压患儿PAMP术后24 h（48.36±5.25） mmHg、术后7 d（28.21±3.29） mmHg、术后30 d（25.21±2.09） mmHg,与术前（60.29±8.48） mmHg比较,差异均有统计学意义（F组内=39.86,P＜0.001）;与无肺动脉高压组[（14.26±1.78）、（14.30±1.92）、（13.31±1.02） mmHg]相比差异有统计学意义（F组间=46.01,P＜0.001）.重度肺动脉高压组血浆血管内皮生长因子及转化生长因子β1水平术后24 h（620.21±30.30）ng/L、（906.20±65.11） ng/L、术后7 d（454.49±21.48） ng/L、（826.23±35.11） ng/L、术后30 d（454.49±21.48） ng/L、（806.49±29.48） ng/L与术前（808.90±41.37） ng/L、（1156.96±83.68） ng/L比较,差异均有统计学意义（F组内=43.73,P＜0.001,F组内=65.41,P＜0.001）,与无肺动脉高压组[血管内皮生长因子（379.25±20.21）、（380.05±19.98）、（380.05±19.98） ng/L;转化生长因子β1（728.56±29.93）、（728.11±25.26）、（727.05±24.99） ng/L]相比差异有统计学意义（F组间=54.09,P＜0.001,F组间=83.05,P＜0.001）.结论 血浆血管内皮生长因子及转化生长因子β1水平与肺动脉压力有关,其对评价肺动脉高压严重程度及手术疗效有一定意义.术后重度肺动脉高压患儿在一定期内仍存在肺动脉高压,应引起足够重视,加强治疗与随访.

Objective To observe before and after surgery plasma vascular endothelial growth factor （VEGF） and transforming growth factor beta 1 （TGF-β1） content changes in the children with congenital heart disease（CHD） combined severe pulmonary arterial hypertension（PAH）,and to explore the relationship with the pulmonary artery pressure.Methods Sixty cases patients with CHD in the First Hospital of Hebei Medical University from June 2014 to January 2015 were selected,including 30 cases left to right shunt CHD with severe PHD,30 cases no PHD.The content of serum VEGF,TGF-β1,parallel echocardiographic estimates pulmonary artery mean pressure（PAMP） of all children were detected with preoperative and postoperative 24 h,7 d and 30d.Results PAMP of children with severe PAH before surgery was （60.29±8.48） mmHg and （48.36±5.25）mmHg of postoperative 24 h,（28.21±3.29） mmHg of 7 d after surgery,（25.21±2.09） mmHg of 30 d after surgery,the difference was statistically significant （F within the grouP=39.86,P〈0.001）,and compared with no PHD group,the difference was significant （（14.26±1.78） mmHg,（14.30±1.92） mmHg,（13.31±1.02）mmHg;F between groups=46.01,P〈0.001）.The levels of VEGF and TGF-β1 in severe PHD group were （808.90±41.37） ng/L and （1156.96±83.68） ng/L of before operation,（620.21±30.30） ng/L and （906.20±65.11） ng/L of postoperative 24 h,（454.49±21.48） ng/L and （826.23±35.11） ng/L of postoperative 7 d,（454.49±21.48） ng/L and （806.49±29.48） ng/L of postoperative 30 d,the differences were significant （Fwithin the grouP=43.73,P〈0.001;F within the grouP=65.41,P〈0.001）,compared with no PHD group,the differences were significant （VEGF：（379.25±20.21） ng/L,（380.05±19.98） ng/L,（380.05±19.98） ng/L,F between groups =54.09,P〈0.001;TGF-β1：（728.56±29.93） ng/L,（728.11±25.26） ng/L,（727.05±24.99） ng/L,F between groups=83.05,P〈0.001）.Conclusion Plasma VEGF and TGF-β1 level has correlation with pulmonary artery pressure,the severity evaluation of pulmonary hypertension and surgical curative effect has a certain significance.After surgery,severe PAH is still exist in a certain period in children with pulmonary hypertension,sufficient attention should be paid to strengthening treatment and follow-up.