动脉导管未闭患儿介入治疗前后血浆N末端脑利钠肽水平及心功能变化

Percutaneous Closure of Patent Ductus Arteriosus on Plasma N-Terminal Brain Natriuretic Peptide Level and Left Ventricular Function

目的应用心脏超声技术及检测血浆N末端脑利钠肽(NT-proBNP)水平,探讨经皮动脉导管未闭(PDA)封堵术对心功能影响。方法PDA患儿55例,术前按照小儿心衰改良Ross标准分为无心衰组31例,轻度心衰组14例,中重度心衰组10例(重度心衰1例)。选择年龄、体质量相匹配健康儿童15例作为健康对照组。应用酶联免疫吸附法测定血浆NT-proBNP水平。同时测定左室舒张末期容量指数(LVEDVI)、左室收缩末期容量指数(LVESVI)、左室射血分数(LVEF)、左室缩短分数(LVFS)等反映心室功能及负荷的超声心动图指标。结果1.PDA患儿术前LVEDVI、LVESVI均显著高于健康对照组(Pa<0.01),且各组间随着心功能严重程度增加而显著升高(P<0.01)。2.术前血浆NT-proBNP水平随着心功能严重程度增加而升高,中重度心衰组高于轻度心衰组(P<0.01),轻度心衰组高于无心衰组(P<0.01),无心衰组与健康对照组比较无统计学差异(P>0.05)。3.PDA患儿术后3个月血浆NT-proBNP水平、LVEDVI、LVESVI均较术前显著降低(Pa<0.01),接近健康对照组水平(P>0.05)。4.血浆NT-proBNP水平与LVESVI(r=0.653P<0.01)、LVEDVI(r=0.741P<0.01)呈正相关,而与LVEF、LVFS等无显著相关性(P>0.05)。结论PDA堵闭术后3个月在临床症状和反映左室功能超声指标明显改善同时,术前高血流动力学负荷对心室细胞影响也逐渐恢复。

Objective To evaluate the effect of percutaneous closure of patent ductus arteriosus （PDA） on left ventricular size and function by measuring plasma N - terminal brain natriuretic peptide （ NT - proBNP） level and using two - dimensional echocardiography. Methods According to the modified Ross score,55 children with PDA were divided into 3 groups, no congestive heart failure（CHF） group（ 31 cases）, mild CHF group（ 14 cases） and moderate- severe CHF group（ 10 cases）. Fifteen age- matched and weight- matched normal children were used as controls. Plasma NT - proBNP was measured using enzyme - linked immunosorbent assay（ELISA）. All patients had complete echocardiographie study, including measurement of left ventricular end diastolic volume index （ LVEDVI）, left ventricular end systolic volume index （.LVESVI）, and left ventrictdar ejection fraction（LVEF） ,and left ventricular fractional shortening（LVFS）. The correlation between plasma NT - proBNP level and echocardiographic cardiac functional indexes was determined. Results 1. Before operation LVEDVI and LVESVI in PDA patients were obviously higher than those in normal controls （ P〈0.01 ）. LVEDVI and LVESVI in moderate - severe CHF group were significantly elevated compared with mild CHF group（P 〈0. 01 ） ,and those subjects in mild CHF group were obviously higher than those in no CHF group （P 〈 0. 01 ）. 2. Before operation plasma NT - proBNP level in moderate - severe CHF group was significantly elevated compared with mild CHF group （P 〈0. 01 ） ,and it was obviously higher in mild CHF group than that in no CHF group and normal controls（P 〈0.01 ）. There was no significant difference between no CHF group and normal controls （ P 〉 0.05 ）. 3. Three months after operation plasma NT - proBNP level, LVEDVI and LVESVI were significantly decreased （ P〈 0.01 ）. 4. Plasma NT - proBNP level was positively correlated with LVESVI（ r = 0. 653 P 〈 0.01 ） and LVEDVI（ r = 0. 741 P 〈 0.01 ）. There was no correlation among NT- proBNP level, LVEF, and LVFS. Conclusions Left ventficular volume load and function of PDA children recovered in 3 months after percutaneous closure. Even the hemodynamic overload on ventricular cells disappeared.