先天性心脏病肺动脉高压患儿左室舒张功能与血浆脑利钠水平的相关性研究

Correlation between left ventricular diastolic function and plasma natriuretic peptide level in children with pulmonary artery hypertension secondary to congenital heart disease

目的探讨先天性心脏病(CHD)合并肺动脉高压(PAH)患儿脑利钠肽(BNP)水平及与左室舒张功能的关系。方法对95例CHD继发有PAH的患儿和42例无PHA的CHD患儿(对照组)的多普勒超声心动图资料与其血浆BNP水平进行对比分析。结果与对照组相比,PAH组的左室舒张末内径(LVDd)、右室舒张末内径(RVDd)和肺动脉内径(PAd)明显增大(P<0.05),三尖瓣返流(VTR)速度增快及肺动脉收缩压(PASP)升高(P<0.05)。与对照组比较,PASP组患儿二尖瓣口多普勒血流频谱A峰流速(AV)、A峰流速积分(AVI)和E峰流速积分(EVI)及AV/EV和AVI/EVI比均逐渐明显增大(P<0.01);左室等容舒张时间明显延长(LIVRT)(P<0.05)。血浆BNP水平随着PASP增高而升高,与对照组相比差异有显著性(P<0.01)。PAH组先心病患儿其肺动脉压与二尖瓣口血流频谱AV/EV比值呈正相关(P<0.01),二尖瓣口血流参数与血浆BNP水平亦呈正相关(P<0.01)。结论CHD合并PAH患儿左室舒张功能与血浆BNP水平呈正相关;BNP在PAH引起左室舒张功能障碍的发生发展过程中发挥了重要作用。

Objective To study the plasma natriuretic peptide （BNP） level in children with pulmonary artery hypertension （PAH） secondary to congenital heart disease （CHD） and its correlation with left ventricular diastolic function. Methods Doppler eehocardiography was performed on 95 CHD children with PAH （ PAH group ） and on 42 CHD without PAH （control group ）. The plasma BNP level was measured using radioimmunity assay. Results Doppler echoeardiography showed that the left ventricular end-diastolic diameter （LVDd）, the right ventricular diameter end-diastolic （RVDd）, and the pulmonary artery diameter （PAd） increased significantly in the PAH group compared with those in the control group （P 〈 0.05）. The PAH group had higher velocity of tricuspid regurgitation （VTR） and higher pulmonary artery systolic pressure （PASP） than the control group （P 〈 0.05 ）. The PAH group also had higher mitral A peak velocity （ AV）, higher mitral A peak velocity integral （ AVI）, higher E peak velocity intgral （ EVI）, and higher ratio of mitral AV to mitral E peak velocity （EV） and AVI/EVI ratio as well as prolonged left ventricular volumetric relaxation time than the control group. PASP was positively correlated with the AV/EV ratio （P 〈 0.05 ）. The plasma BNP level in the PAH group increased significantly compared with that in the control group. In the PAH group, the plasma BNP level was positively correlated with the puhnonary artery pressure and the ratio of AV/EV. Conclusions The left ventricular diastolic function is positively correlated with the plasma BNP level in children with PAH secondary to CHD. BNP may play an important role in the generation and development of left ventricular diastolic dysfunction induced by PAH.