先天性心脏病肺动脉高压患者心房钠尿肽及内皮素含量的临床观察

Clinical studies of atrial natriuretic peptide and endothelin in patients with congenital heart disease with pulmonary hypertension

目的:观察先天性心脏病（先心）肺动脉高压（PH）患者心房钠尿肽（ANP）、内皮素（ET）含量变化，探讨其作用机理及临床价值。方法：82例先心患者以肺动脉压超过2kPa为PH组．小于2kPa为非肺动脉高压（Non－PH）组，另选择健康儿童为对照组。取外周血测ANP，取外周及心脏多部位血测ET。结果：（1）血浆ANP：PH组与Non－PH组、对照组有显著差别（P＜0．01）。（2）血浆ET：外周静脉、腔静脉、右心房、右心室、肺动脉、左心房等部位血浆ET水平PH组显著高于Non－PH组、对照组，其中左心房ET水平最高（P＜0，01）。结论：（1）先心PH使心房容量及压力负荷增加，促进ANP释放增加。PH时内源性ANP增多实为代偿机理。（2）ET在发病中有重要意义，对PH诊断有一定的临床价值。（3）ET可以引起ANP释放，再通过负反馈作用抑制ET效应，两者对心血管作用互为桔抗，互为制约。

To observe the changes of artrial natriuretic peptide (ANP) and endothelin (ET) lev-els in patients with c0ngenital heart disease (CHD) and discuss their mechanism and clinical significance.Methods: The pulmonary pressure of the pulmonary hypertension (PH)group was higher than 2 kPa- Thepulmonary pressure of Non-PH group was n0rmal. Healthy children served as control group. Results: (1)Plasma ANP level of the PH group was apparently higher than that 0f the N0n-PH group and c0ntrolgroup. (2) Plasma ET levels in the peripheral vein, vena cava,right atrium, right ventricle, pulmonaryartery and left atrium of the PH group were particularly higher than that of the Non-PH group and c0ntr0lgroup, especially in the left atrium. C0nclusi0n: (l) CHD with PH induces the increase in cardiac v0lumeand pressure load, thus accelerates the release 0f ANP. It is actually a compensatory mechanism for the el-evation of endogenic ANP. (2) ET is a vasoconstrictor. ET owns the importance at PH pathogenesis andhas a certain clinical value in the diagn0sis 0f PH. (3) ET causes ANP releasing, then inhibits ET effectthrough negative feed. B0th of them are antag0nists each other.