动脉导管未闭封堵术对Tei指数及心脏内分泌的影响

The Changes of Tei Index and Natriuretic Peptides after Transcatheter Closur of Patent Ductus Arteriosus

目的:研究经皮动脉导管未闭(PDA)介入封堵术对血浆心钠肽(ANP)、脑钠肽(BNP)、心功能Tei指数的影响,并探讨Tei指数与ANP、BNP变化的相关性及其临床意义。方法:选择南昌大学第一附属医院施行PDA经导管封堵术的患者16例,并选择年龄相当的16名健康人作为对照组。采用放射免疫与酶联免疫法分别检测2组患者术前及术后10min、2d、3个月的血浆ANP、BNP水平。应用超声心动图测定左、右心室Tei指数,并将PDA封堵术前后左心室Tei指数的变化与血浆ANP及BNP的变化作相关性分析。结果:①PDA患者术前血浆ANP和BNP水平较正常组显著升高(P<0.01),术后10min、2d患者血浆ANP、BNP水平较术前显著升高(P<0.01),术后3个月血浆ANP和BNP水平均恢复到正常范围。②PDA患者术前左心室Tei指数较正常组显著升高(P<0.01),术后2d左心室Tei指数较术前显著升高(P<0.01),术后3个月左心室Tei指数恢复到正常范围,PDA患者封堵术前后右室Tei指数变化无显著差异(P>0.05)。③PDA封堵术后Tei指数的变化与血浆ANP和BNP水平的变化呈正相关。结论:①介入封堵治疗后PDA患者血浆ANP及BNP水平及Tei指数短期内均显著升高,术后3个月恢复正常。②介入封堵治疗后短期内Tei指数的变化与血浆ANP及BNP水平的变化呈正相关。血浆ANP、BNP水平和Tei指数均可以作为反映心功能变化的可靠指标。

Objective：To observe the changes of plasma atrial natriuretic peptide（ANP）, brain natriuretic peptide（BNP） and myocardial performance index （Tel index） in patients with patent ductus arteriosus（PDA） treated by transcatherter closure, and identify its correlation. Methods： Sixteen patients with PDA underwent transcatheter closure using occluder. The plasma concentration of ANP and BNP were measured before and at 10 minutes,2 days and 3 month after closure. The Tei index of left and right ventricular were measured with echocardiograph before and 2 days and 3 month after transcatheter closure, respectively. Results： The plasma concentration of ANP and BNP of all the cases before the transcatheter closure were significantly hJgher than those of the controls （P〈0. 01）. Ten mintes and 2 days after the transcatheter closure, ANP,BNP got even more higher than before transcatheter closure and the controls （P〈0.01）. Tel index of LV before the transcatheter closure were significantly, higher than the controls （P〈0.01）. Two days after the transcatheter closure,Tei index of LV got even more higher than before transcatheter closure. Those of after closure of PDA correlated well with ANP and BNP. There were a positive correlation between the changes of Tei index of LV and the change of ANP and BNP at 2 days. The concentration of ANP and BNP and Tel index returned to normal 3 months after transcatheter closure. Conclusion： After the patients with PDA treated by transcatheter closure, the ANP and BNP once reached a higher level but went to normal soon. There is a positive correlation be- tween the plasma concentration of ANP/BNP and Tei index of LV. The concentration of plasma ANP/BNP as well as Tel index is an effective index to predict the heart function and efficiency of transeatherter closure.