左向右分流先天性心脏病儿童红细胞氧化应激状态相关研究

Erythrocyte oxidative stress in children with left to right shunt congenital heart disease

目的研究左向右分流型先天性心脏病(先心病)患儿红细胞氧化应激状态,探讨其相互关系及临床意义。方法左向右分流先心病患儿31例为实验组,再根据解剖特点分为亚组,其中房间隔缺损(ASD)7例、室间隔缺损(VSD)12例、动脉导管未闭(PDA)4例、卵圆孔未闭(PFO)6例、完全性心内膜垫缺损(复杂组)2例;门诊健康体检儿童20例为对照组,两组年龄均为1月至3岁。用酶联免疫法(ELISA法)测定红细胞内超氧化物歧化酶(SOD)及丙二醛(MDA)含量;魏氏法检测ESR,血气分析仪(GEMPremier3000)测定PaO2、PaCO2。结果先心病组与对照组比较红细胞内MDA含量升高,SOD含量降低,两组比较差异有统计学意义(P<0.05);合并心力衰竭时SOD较对照组下降更为明显,MDA含量明显升高,差异有统计学意义(P<0.01)。各解剖分型组中,SOD含量以PFO组最高,复杂组最低,PFO组与ASD组、VSD组、复杂组间比较差异有统计学意义(P<0.05);MDA含量以VSD组最高,PFO、ASD及PDA组有所降低,复杂组最低,组间比较差异有统计学意义(P<0.05)。相关分析显示先心病组ESR及MDA含量与SOD含量的改变呈负相关(r=-0.191,r=-0.312;P<0.05),而ESR与PaO2的变化呈正相关(r=0.216,P<0.05)。结论左向右分流先心病患儿体内存在氧化应激,测定红细胞SOD、MDA含量可较好反映疾病严重程度。

Objective To study erythrocyte oxidative stress status and its association with left to right shunt congenital heart disease（CHD）in children.Methods A total of 31 children with left to right shunt CHD were enrolled,including 7 cases of atrial septal defect（ASD）,12 ventricular septal defect（VSD）,4 patent ductus arteriosus（PDA）,6 patent foramen ovale（PFO）,and 2 complete endocardial cushion defect.Twenty healthy age-matched（1 month to 3 years old）children severed as the control group.The contents of superoxide dismutase（SOD）and malonaldehyde（MDA）in erythrocytes were determined using ELISA.ESR was measured by Westergen.PaO2 and PaCO2 were measured by Blood Gas Analyzer（GEM Premier 3000）.Results The MDA content in erythrocytes in the CHD group was significantly higher,in contrast,SOD content was significantly lower than that in the control group（P0.05）.The CHD children with heart failure had more decreased SOD and more increased MDA contents compared with the control group（P0.01）.The SOD level was the highest in the PFO group and was the lowest in the complete endocardial cushion defect group.The SOD level in the PFO group was significantly higher than that in the ASD,VSD and complete endocardial cushion defect groups（P0.05）.The MDA level was the highest in the VSD group and was the lowest in the complete endocardial cushion defect group.There were significant differences in the MDA level among CHD subgroups（P0.05）.The ESR was negatively correlated to the SOD level（r=-0.191,P0.05）,while positively correlated to PaO2 level in CHD children（r=0.216,P0.05）.There was a negative correlation between SOD and MDA levels（r=-0.312,P0.05）.Conclusions Oxidative stress exists in children with left to right shunt CHD.The SOD and MDA contents in erythrocytes can be used as markers for the assessment of severity of the disease.