心力衰竭患儿血浆心房利钠肽水平变化及临床意义

The change of atrial natriuretic peptide level in children with congestive heart failure and clinical significance

目的:探讨心力衰竭患儿血浆心房利钠肽(ANP)的变化及其临床意义。方法:心力衰竭患儿34例,分成3个亚组,Ⅰ度心衰组14例,Ⅱ度心衰组13例,Ⅲ度心衰组7例。分别测定治疗前后血浆ANP水平、血清肌酸激酶同工酶(CK-MB)水平,并作超声心动图检查,观察血浆ANP水平与左室射血分数(LVEF)之间的关系。选取健康儿童20例作为对照组,以了解小儿心力衰竭时ANP、CK-MB变化情况。结果(:1)心力衰竭组ANP、CK-MB水平均明显高于正常对照组,随着心力衰竭程度的加重,血浆ANP水平逐渐增高,与心衰程度呈正相关,与LVEF呈负相关。而CK-MB与心衰程度、LVEF之间均没有相关性。(2)心功能好转后ANP、CK-MB水平均明显下降(P<0.01),LVEF明显增高(P<0.01)。结论:心力衰竭时,血浆ANP水平明显增高,并且与心衰程度、LVEF有较好的关联。

Objective ：To assess the change of atrial natriuretic peptide level in children with congestive heart failure and clinical significance. Methods：34 children with heart failure were divided into Ⅰ,Ⅱ ,and Ⅲ groups according to heart failure diagnostic criteria on Qingdao conference. Plasma ANP and serum CK-MB concentration were determined before and after treatment. All patients had echocardiographic study, including measurement of left ventricular ejection fraction （LVEF）. The relation among ANP,CK-MB and LVEF was studied. 20 healthy children were included in control group, plasma ANP and serum CK-MB concentration were also determined. Results： （1）Plasma ANP and serum CK-MB concentration in children with congestive heart failure were significantly higher than that of control group, and ANP increased with the degree of heart failure, and was positively correlated with the degree of heart failure, and was negatively correlated with LVEF,but CK-MB concentration had nothing to do with the degree of heart failure and LVEF.（2）In children with congestive heart failure, ANP and CK-MB concentration post-treatment were significantly lower than that of pretherapy, and LVEF was significantly higher. Conclusions：Plasma ANP concentration significantly upregulates in children with congestive heart failure, and has good correlation with the degree of heart failure and LVEF.