先心病肺动脉高压与血管紧张素Ⅱ的关系研究

Fluctuation of Angiotension n levels in patients with congenital disease associated with pulmonary hypertension pre-and post- interventional therapy

目的观察先天性心脏病(简称先心病)介入封堵术前后血浆血管紧张素Ⅱ(AngⅡ)的浓度变化,探讨其在先心病肺动脉高压(PH)中的作用及其临床意义。方法选取70例先心病患者,其中房间隔缺损30例、室间隔缺损30例、动脉导管未闭10例,依据心导管测压分为无PH组(20例)、轻度PH组(30例)和中重度PH组(20例)。分别用放射免疫法测定各组患者术前和术后24h、1个月、3个月、6个月血浆AngⅡ浓度。另选取年龄及性别与之相匹配的正常体检儿童30例作为对照组。结果术前先心病伴PH组患者血浆AngⅡ水平明显高于无PH组(P<0．01)。先心病有、无PH 患者介入封堵术后24h,AngⅡ开始缓慢下降,至6个月基本下降到正常水平(P<0．01)。术前血浆AngⅡ浓度与肺动脉压力呈显著正相关(r=0．715,P<0．05)。结论 AngⅡ可能参与了先心病PH的发生、发展过程。

Objective To observe the concentration changes of angiotension Ⅱ （Ang Ⅱ ） levels in congenital heart disease （CHD） before and after interventional therapy, and explore its role in CHI） associated with pulmonary hjpertension （PH）. Methods Seventy patients with CHD were enrolled in this study, of which thirty with atrial septal defects, thirty with ventricular septal defects, and ten with patent arterial duct. According to patients associated with or without PH, all the patients were allocated to an absent PH group （ n =20）, a mild PH group （ n = 30） and a moderate-severe PH group （ n = 20）. A radiolmmunoasay was used to detect the concentration levels of Ang Ⅱ in the above three groups before interventional therapy, and at 24 hours, 1 month, 3 months, 6 months after interventional therapy. Thirty healthy children of the control group were enrolled in this study. Results In patients with CHD associated with PH before interventional therapy, the Ang Ⅱ levels were significantly higher than those in patients without PH （ P 〈 0.01）. In patients with CHD associated with or without PH, 24 hours after interventional therapy, the Ang Ⅱ levels began to slowly decrease, and till the sixth months, it recovered to normal levels （ P 〈 0.01）. Before interventional therapy, the plasma Ang Ⅱ concentration had significantly positive correlation to pulmonary tension （ r = 0.715, P 〈0.05）. Conclusion AngⅡ may play an important role in the pathogenesis of CHK） associated with PH.