左向右分流型先天性心脏病病儿血浆BNP和CT-1变化

CHANGES OF PLASMA LEVELS OF BRAIN NATRIURETIC PEPTIDE AND CARDIOTROPHIN-1 IN CHILDREN WITH LEFT-TO-RIGHT SHUNT CONGENITAL HEART DISEASE

目的探讨左向右分流先天性心脏病(CHD)病儿血浆脑钠肽(BNP)、心脏营养素-1(CT-1)水平的变化及临床意义。方法应用ELISA法测定25例左向右分流CHD病儿和10例正常儿童血浆BNP和CT-1水平,观察血浆BNP和CT-1水平与肺动脉压力、左心室射血分数(EF)、左心室短轴缩短率(FS)、左心室舒张末内径(LVIDd)、左心室收缩末内径(LVIDs)和左心室心肌质量指数(LVMI)的关系。结果与正常儿童比较,左向右分流CHD病儿血浆BNP和CT-1水平明显升高(t=9.50、3.07,P<0.01);肺动脉高压病儿血浆CT-1水平明显高于正常肺动脉压病儿(t=10.92,P<0.01),且左向右分流CHD病儿血浆CT-1水平与肺动脉压力呈正相关(r=0.512,P<0.05),但与EF、FS、LVIDd、LVIDs和LVMI无相关性(P>0.05);左向右分流CHD病儿血浆BNP水平与EF、FS、LVIDd、LVIDs、LVMI和肺动脉压力均无相关性(P>0.05)。结论血浆BNP和CT-1水平能较好地反映左向右分流型CHD病儿的心功能状态,血浆CT-1水平随肺动脉压力升高而升高。

Objective To investigate the changes and clinical significance of plasma levels of cardiotrophin-1（CT-1） and brain natriuretic peptide（BNP） in children with left-to-right shunt congenital heart disease（CHD）. Methods The plasma concentrations of BNP and CT-1 of 25 sick children and 10 healthy ones were measured by using enzyme immunoassay.The relationship between CT-1 or BNP and pulmonary artery pressure（PAP）,ejection fraction,fractional shortening,left ventricular internal diameter at end-diastole（LVIDd）,left ventricular internal diameter at end-systole（LVIDs）,and left ventricular mass index（LVMI） were studied. Results Compared to normal children,the plasma CT-1 and BNP were significantly elevated in the sick children（t=9.50,3.07;P0.01）;the plasma CT-1 in those with pulmonary hypertension was higher than that with normal PAP（t=10.92,P0.01）.The plasma CT-1 in the sick children was positively correlated with PAP（r=0.512,P0.05）,but no correlation with ejection fraction,fractional shortening,LVIDd,LVIDs,LVNI and PAP was found（P0.05）. Conclusion The plasma levels of CT-1 and BNP can better reflect cardiac status in children with left-to-right shunt CHD,and the CT-1 levels increase along with the rising of PAP.