充血性心力衰竭患儿心肌β肾上腺素能受体系统在心室重塑中作用的研究

Regulation of myocardium adrenoreceptor pathway in ventricluar remodeling of children with congestive heart failure

目的：研究充血性心力衰竭（ＣＨＦ）患儿心肌β肾上腺素能受体系统在左室重塑中的作用。方法：采用高效液相色谱电化学法对１８例ＣＨＦ患儿测定血浆去甲肾上腺素（ＮＥ）、肾上腺素（Ｅ）浓度，用３Ｈｄｉｈｙｄｒｏａｌｐｎｅｏｌｏｌ（３ＨＤＨＡ）放射配基结合分析法测定外周血淋巴细胞β受体密度最大值（Ｂｍａｘ），并以心脏超声仪测定和计算左心室心肌重量指数（ＬＶＭＩ）。结果：ＣＨＦ患儿ＬＶＭＩ正常组血浆ＮＥ、Ｅ分别为（５２０．１±１８７．３）μｇ／Ｌ和（２９４．１±１７８．４）μｇ／Ｌ，显著高于正常对照组〔（１８９．３±９２．４）μｇ／Ｌ和（９４．５±４５．１）μｇ／Ｌ；ｔ＝６．５３８和ｔ＝１０．２７，Ｐ均＜０．００１〕；Ｂｍａｘ〔（３７８．７±９７．２）ｆｍｏｌ／１０６〕低于正常对照组〔（５６８．２±１０１．８）ｆｍｏｌ／１０６，ｔ＝４．８７６，Ｐ＜０．００１〕，ＬＶＭＩ增高组Ｂｍａｘ〔（２６８．５±８５．６）ｆｍｏｌ／１０６〕显著低于ＬＶＭＩ正常组〔（３７８．７±９７．２）ｆｍｏｌ／１０６〕；Ｂｍａｘ与ＬＶＭＩ显著负相关（ｒ＝－０．６９，Ｐ＜０．０１）。结论：血浆ＮＥ、Ｅ浓度和外周血淋巴细胞Ｂｍａｘ可作为判断心功能受损程?

Objective :To study the role of myocardium adrenoreceptor pathway in ventricular remodeling of children with congestive heart failure (CHF). Methods :Plasma concentrations of norepinephrine (NE) and epinephrine (E) were measured by high performance liquid chromatography electro chemistry detection (HPLC ED) in 18 children with CHF. adrenergic receptor density (Bmax) of lymphocyte was determined by3H dihydroalpneolol (3H DHA) as ligand,and left ventricle mass index (LVMI) by echocardiogram. Results :Plasma NE and E levels were significantly increased (52011873)g/L and (29411784)g/L,and the Bmax was decreased (3787972)fmol/106 in normal LVMI patients compared with the controls (1893924)g/L,(945451)g/L,and (56821018)fmol/106,all P<0001.Also,the Bmax decreased more significantly in patients with abnormal LVMI than that in normal LVMI patients (2685856)fmol/106 vs.(3787972)fmol/106,and that was significantly negatively correlated with LVMI (r=-069,P<001). Conclusions :Plasma NE and E levels,as well as Bmax of lymphocytes may be useful parameters to reflect the severity of heart dysfunction in patients with CHF.The regulation of myocardium adrenoreceptor pathway is earlier than the pathologic structural change of left ventricular remodeling.It is sugested that remodeling of LV might be regulated by myocardial adrenoreceptor pathway.