慢性充血性心力衰竭患儿血浆儿茶酚胺、心钠素水平的意义

Changes of Plasma Satecholamines and Atrial Natriuretic Peptide in Children with Chronic Heart Failure and Its Clinical Significance

目的探讨慢性充血性心力衰竭(CHF)患儿血浆儿茶酚胺(CA)[包括肾上腺素(E)、去甲肾上腺素(NE)]、心钠素(ANP)水平变化及其与心脏左室功能的关系。方法选择CHF患儿及正常对照组各35例,测定其血浆NE、E及ANP水平,检测左室射血分数(LVEF)。结果1.CHF组治疗前血浆NE、E、ANP水平显著高于正常对照组,二组比较差异有显著性(Pa<0.01)。2.CHF组治疗前显著高于抗心力衰竭综合治疗心力衰竭好转后血浆NE、E、ANP水平,二组比较差异有显著性(Pa<0.01)。3.CHF组治疗后血浆NE、E、ANP水平显著高于正常对照组,二组比较差异有统计学意义(Pa<0.05)。4.CHF组心功能越差,血浆NE、E、ANP升高越明显,差异有显著性(P<0.01)。5.以35例CHF患儿血浆NE、E、ANP为自变量,LVEF为应变量作直线相关分析,显示CHF组血浆NE、E、ANP与LVEF呈显著负相关。结论CA、ANP水平与CHF程度密切相关,心功能下降可能与CA、ANP水平过度生成有关,其可作为评价CHF的指标之一。

Objective To explore the changes of plasma catecholamines （ CA ） [ including epinephrine （ E ） and norepinephrine （ NE ） ] and atrial natriuretic peptide （ANP） in children with varying degrees of left ventricular ejection function （LVEF） in chronic heart failure （ CHF）, and establish natriuretic hormone factors as one of the diagnostic criteria of CHF. Methods Thirty - five patients with CHF and 35 children in good health were enrolled ,and the concentration of plasma NE, E, ANP and the LVEF were determined. Results 1. The levels of plasma NE, E and ANP in 35 patients with CHF before treatment were significantly higher than those in control group（ Pa 〈 0. 01 ）. 2. The levels of plasma NE, E and ANP in 35 patients with CHF before treatment were significantly higher than after treatment（ Pa 〈 0.01 ）. 3. The levels of plasma NE, E and ANP in 35 patients with CHF after treatment were significantly higher than those in control group（ Pa 〈 0. 05 ）. 4. There was a highly significant increase in NE, E, ANP consistent with the severity of heart failure（ P 〈0. 01 ）. 5. The levels of plasma NE, E and ANP with CHF patients had obvious negative correlation with LVEF. Conclusion The CA and ANP were closely correlated with cardiac function. The reduction of cardiac function in children may be related to the excessive production of the CA and ANP. Natriuretic hormone factors may serve as one of the diagnostic criteria of CHF.