病毒性心肌炎患儿血浆内分泌素的改变及其临床意义的探讨

Theplasmaendocrinechangesinchildrenwithacuteviralmyocarditis

采用放射免疫法测定４７例急性病毒性心肌炎患儿及２０例正常儿童血浆肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＰＡⅡ）、醛固酮（ＰＡＬＤ）、心钠素（ＰＡＮＦ）的水平，以探讨病毒性心肌炎发病机制以及以上４种内分泌素在其临床中的意义。结果表明，心肌炎患儿（心功能为１和２级）与正常儿童相比，ＰＲＡ没有明显改变，ＰＡⅡ、ＰＡＬＤ及ＰＡＮＦ皆显著升高；ＰＡⅡ、ＰＡＬＤ、ＰＡＮＦ三者之间分别呈正相关关系；心肌炎组中表现为心肌缺血及心律失常的两个组间ＰＡⅡ、ＰＡＬＤ、ＰＡＮＦ没有显著差异。说明心肌炎急性期肾素－血管紧张素－醛固酮系统（ＲＡＡＳ）被激活，以维持心排血量和血压，增加血管阻力。同时，心肌细胞ＡＮＦ的合成和分泌增加，通过排钠、利尿。

Wemeasuredplasmareninactivity(PRA)andconcentrationsofplasmaangiotensionⅡ(PAⅡ),aldosterone(PALD),atrialnatriureticfactor(PANF)of47childrenwithacuteviralmyocarditisbyradioimmunoassaytostudythepathogenesisofmyocarditisandtheclinicalsignificanceofthefourendocrines.TheresultsshowedthatthelevelsofPAⅡ,PALDandPANFinpatientsweresignificantlyhigherthanthoseofcontrolsexceptthatofPRA,andthereweremoderatelytohighlypositivecorrelationsbetweenPAⅡandPALD,PANFandPAⅡ,andPANFandPALD,re-spectively.However,theconcentratioinsofPAⅡ,PALDandPANFhadnodiferencebetweenmy-ocardialischemiapatientsandarrhythmiapatients.Theseresultssuggestedthatintheacutestageofviralmyocarditis,RAASbeactivatedtomaintaincardiacoutputandbloodpressurefolowingin-creasingvascularresistance.Atthesametime,thesynthesisandsecretionofANFbymyocardialcelsincreasedtoantagonizecardiacoverloadcausedbyRAASthroughnatriuresis,diuresisandva-sodilation.