先天性心脏病并肺动脉高压患儿血浆尾加压素Ⅱ与血管内皮生长因子水平的变化

Changes of Plasma Urotensin Ⅱ and Vascular Endothelial Growth Factor in Children with Pulmonary Hypertension Associated with Congenital Heart Disease

目的通过检测左向右分流型先天性心脏病(CHD)并肺动脉高压(PH)患儿血浆尾加压素Ⅱ(UⅡ)与血管内皮生长因子(VEGF)的水平,探讨其在左向右分流型CHD并PH中的临床意义。方法选择2008年1月-2009年1月本院心儿科收治的63例左向右分流型CHD患儿(男30例,女33例),均在右心导管检查中直接测定其肺动脉压力,按肺动脉平均压(mPAP)水平分为无PH组(mPAP≤25mmHg,1mmHg=0.133kPa)21例、轻中度PH组(25mmHg<mPAP≤45mmHg)20例及重度PH组(mPAP>45mmHg)22例。取患儿肺动脉血,采用酶联免疫吸附法(ELISA)测定其肺动脉血浆UⅡ及VEGF水平,分析二者与mPAP的关系。结果 1.无PH组、轻中度PH组及重度PH组肺动脉血浆UⅡ水平比较差异无统计学意义(P>0.05)。肺动脉血浆UⅡ水平与mPAP无相关性(r=-0.003,P>0.05)。2.轻中度及重度PH组与无PH组肺动脉血浆VEGF水平比较差异均有统计学意义(Pa<0.01),轻中度PH组与重度PH组肺动脉血浆VEGF水平比较差异亦有统计学意义(P<0.05);肺动脉血浆VEGF水平与mPAP呈正相关(r=0.761,P<0.01)。结论 1.血浆UⅡ水平随PH程度的加重无明显变化,但不能排除UⅡ在PH形成和血管重建中起重要作用。2.VEGF参与了左向右分流型CHD并PH的病理生理过程,其血浆水平可作为评估左向右分流型CHD患儿PH严重程度的参考指标之一。

Objective To study the clinical significance of plasma urotensin 11 （ U II ） and vascular endothelial growth tactor （VEGF） in children with pulmonary hypertension（PH） associated with left - to - right shunt congenital heart disease （CHD） by detecting the levels of plasma U II and VEGF. Methods From Jan. 2008 to Jan. 2009, a total of 63 children with left - to - right shunt CHD who hospitalized in Beijing Anzhen ttospital were enrolled in the study. Thirty children were male, others were female. Mean pulmonary artery pressure （mPAP） of 63 cases was measured by right heart catheterization. They were divided into 3 groups according to mPAP level as follows：non - PH group （mPAP ≤ 25 mmHg, n = 21 ）, mild and moderate PH group（25 mmHg 〈 mPAP ≤45 mmHg, n = 20 ） , severe PH group （ mPAP 〉 45 mmHg, n = 22 ）. The blood was drawn from children＇s pulmonary artery. The levels of plasma U II and VEGF were detected by enzyme - linked immunosorbentassay（ELISA）. The relation between the 3 groups and their mPAP were analyzed. Results 1. The level of plasma U II obtained from pulmonary artery was no difference in non -PH group,mild and moderate PH group and severe PH group（P 〉 0.05 ）. There was no correlation beween the level of plasma U II arid mPAP（ r = -0. 003 ,P 〉0. 05 ）. 2. The level of plasma VEGF obtained from puhnonary artery in CHD with PH groups was different significantly from non -PH group（ P 〈 0. 01 ）. There was also significant difference between mild and moderate PH group and severe PH group（ P 〈 0.05 ）. There was positive correlation between the level of plasnm VEGF and mPAP（r = 0. 761 ,P 〈 0.01 ）. Conclusions 1. The level of plasma U II do not change with the increasing of mPAP,but U 1I might play an important role in the formation of PH and restructure. 2. VEGF might participate in the physiopathologic process in children with PH associated with left - to - right shunt CHD. The level of VEC-F can be used as a reliable indicator to evaluate the severity of PH associated with left - to - right shunt CHD.