脑钠肽及超声右心功能指标在诊断小儿先天性心脏病相关肺动脉高压严重程度中的应用

Application of Brain Natriuretic Peptide and Right Ventricular Function Index in Diagnosis of Congenital Heart Disease Associated Pulmonary Hypertension

目的探究脑钠肽及超声右心功能指标在诊断小儿先天性心脏病相关肺动脉高压(PAH)严重程度中的应用。方法取2012年2月至2014年12月大连大学附属瓦房店医院收治的100例先天性心脏病患儿作为研究对象。根据是否发生肺动脉高压分为无PAH组(50例)、轻度PAH组(18例)、中度PAH组(20例)和重度PAH组(12例)。采用酶联免疫吸附法(ELISA)测定血浆脑钠肽水平,通过超声检查测定右心功能相关指标,观察不同肺动脉高压组间脑钠肽水平及肺、体循环血流量比值(Qp/Qs)、右心室变化率(FAC)及右心室心肌工作指数(Tei指数)的水平。结果无PAH组患儿脑钠肽水平、Qp/Qs、FAC分别为(33.5±4.3)μg/L、(1.5±0.3)、(52.3±4.9)%,低于轻度PAH组[(56.3±7.2)μg/L、(2.3±0.3)、(45.8±4.1)%],中度PAH组[(102.4±13.4)μg/L、(3.0±0.4)、(36.3±6.0)%]和重度PAH组[(145.4±20.3)μg/L、(3.4±0.4)、(30.2±5.8)%](P<0.05),轻度PAH组低于中度PAH组和重度PAH组,而中度PAH组低于重度PAH组(P<0.05);无PAH组患儿的FAC大于轻度PAH组、中度PAH组和重度PAH组;轻度PAH组大于中度PAH组和重度PAH组,中度PAH组高于重度PAH组(P<0.05)。重度PAH组患儿的Tei指数高于其他三组(P<0.05),而无、轻、中PAH组比较差异无统计学意义(P>0.05)。结论血清脑钠肽、Qp/Qs以及Tei指数平越高,FAC越低,PAH的病情越严重。

Objective To explore the application of brain natriuretic peptide and ultrasound fight heart function index in the serious of congenital heart disease associated with pulmonary hypertension （PAIl）. Methods Total of 100 patients with congenital heart disease from Febr. 2012 to Dec. 2014 in Wafangdian Hospital Affiliated to Dalian University was selected as the objects. According to the pulmonary hypertension degrees, the patients were divided into PAH group （50 cases） ,mild PAH group （18 cases） ,moderate PAH group （20 cases） and severe PAH group （12 cases）. Adopting enzyme linked immunosorbent assay to detected the brain natriuretic peptide levels, according to tdtrasonography, detected the fight heart function index. Compared the brain natriuretic peptide levels, QWQS, fight ventricular change rate （FAC） and right ventfieular myocardial performance index （Tel index） levels of the four groups. Results The brain natriuretic peptide, Qp/ Qs,FAC of PAH group,mild PAH group,moderate PAH group and severe PAH group were different [ （33.5 ±4, 3）μg/L, （1.5±0.3）,（52.3±4.9）% vs （56.3±7.2） μg/L,（2.3±0.3）,（45.8±4.1）% vs （102.4± 13.4） μg/L,（3.0± 0.4） ,（36.3±6.0）% vs （145.4±20.3） μg/L,（3.4±0.4） ,（30.2±5.8）% ] （P 〈0.05）.The brain natfiuretie pep- tide level and Qp/Qs of PAH group were lower than mild PAil group,moderate PAH group and severe PAll group,mild PAH group was lower than moderate PAH group and severe PAH group, moderate PAH group was lower than severe PAH group. The FAC of PAH group was higher than mild PAH group, moderate PAH group and severe PAH group, mild PAH group was higher than moderate PAH group and severe PAH group, moderate PAH group was higher than severe PAH group （P 〈 O. 05）. Tei index of severe PAH group was higher than the other three groups （P 〈 0.05 ） , there was no significance different between the other three group （P 〉0. 05）. Conclusion The levels of serum brain natriuretic peptide, Qp/Qs and Tei index are higher, the FAC level is lower,the PAH is more serious.