先心病血浆心钠素、环核苷酸与肺血流动力参数关系及术后变化

Relationship between plasma ANP, cyclic nucleotide and pulmonry hemodynamics and the changes after operation in the patients with congenital heart disease

目的研究先心病患者外用静脉血心钠素、环核苷酸与肺血流动力参数关系及外科矫治术后的变化。方法经临床确诊的３２例先心病人，用放射免疫法同步测定血中ＡＮＰ及环核苷酸浓度。术前对２１例患儿行右心导管检查并监测其血流动力参数。结果左向右分流型先心病人，血浆ＡＮＰ、ｃＧＭＰ明显高于对照组，二者呈正相关；血浆ＡＮＰ、ｃ－ＧＭＰ与肺动脉压相关显著，而与右房、右室压无相关性。术后７～１８天血中ＡＮＰ、ｃＧＭＰ含量无明显下降。结论左向右分流的先心病人，心房扩张，血浆ＡＮＰ值升高；血浆ｃＧＭＰ浓度随ＡＮＰ的不同而变化，提示ｃＧＭＰ是ＡＮＰ的第二信使；手术前后血中ＡＮＰ、ｃＧＭＰ水平无明显差异，可能与肺动脉压及肺血管阻力尚未降至正常有关。

The relationshiop between the peripheral vein blood concentrations of atrial natriuretic peptide(ANP),cyclic nucleotide and pulmonary hemodynamics and changes in them after surgical correction in patients with congenital heart disease(CHD)were studied.Methods The 32 cases of CHD were diagnosed in clinic, simultaneous measurements of plasma ANP and cyclic nucleotide levels were performed by radioimmunoassy. Before operation,the right heart catheterization were carried out in 21 of 32 patients and the hemodynamic date were monitored.Results The patients with CHD of left-to-right shunts show significantly higher ANP, cGMP levels than control children, the plasma ANP show a significant positive correlation with cGMP.The plasma ANP, cGMP show a significant correlation with pulmonary artery pressures.Plasma ANP,cGMP values are not correlated with right atrial and ventrical pressure.plasma ANF,cGMP concentrations do not deerease significantly from 7 to 18 days after operation.Conclusions The patients with CHD, left-to-right shunts, which results in distention of the atria,plasma concentations of ANP,cGMP are increased. The changes in plasma ANP levels are followed by changes in plasma cGMP and suggest that cGMP should be a second messenger of ANP. There are no significant difference in plasma ANP, cGMP levels either pre-operation or post-operation. It is possible that pulmonary artery pressure and pulmonary vascular resistance do not drop to normal values.