先天性心脏病合并肺动脉高压手术前后血浆内皮素和肾素—血管紧张素Ⅱ变化以及相互关系

The Change and Interrelationship of Plasma Renin-Angiotensin Ⅱ and Endothelin Before and After Surgery of Congenital Heart Disease with Pulmonary Hypertension

目的监测先天性心脏病合并肺动脉高压患者手术前后血浆肾素-血管紧张素Ⅱ和内皮素浓度变化,探讨肾素-血管紧张素Ⅱ和内皮素与肺动脉压力的关系,以及肾素-血管紧张素Ⅱ与内皮素的相互关系。方法随机选取2008年6月至2009年4月北京大学深圳医院心血管外科24例先天性心脏病患者作为研究对象,术前麻醉经中心静脉留置漂浮导管测定肺动脉压力,并根据肺动脉压力将其分为三组,先天性心脏病无肺动脉高压组,轻度肺动脉高压组以及度肺动脉高压组各8例。检测各组患者术前,术后及康复出院时血浆中肾素、血管紧张素Ⅱ以及内皮素浓度并进行相关性统计分析。结果 1、术前无肺高压组、轻度肺高压组、中重度肺高压组血浆内皮素浓度测值分别为(32.9±5.8),(42.8±4.9),(60.8±15.4);经线性相关回归分析,先心病合并肺高压内皮素与肺动脉压力两者之间呈正相关。2、术前无肺高压组、轻度肺高压组、中重度肺高压组血浆肾素浓度测值分别为(3211.7±1241.2),(4569.9±1155.2),(6989.0±990.1);经线性相关回归分析,先心病合并肺高压肾素与肺动脉压力两者之间呈正相关。3、术前无肺高压组、轻度肺高压组、中重度肺高压组血浆血管紧张素Ⅱ浓度测值分别为(44.6±12.9)、(64.1±9.9)、(69.0±10.9);经线性相关回归分析,先心病合并肺高压血管紧张素Ⅱ与肺动脉压力两者之间呈正相关。4、利用线性相关统计学方法得知,在中重度肺动脉高压患者组肾素以及血管紧张素Ⅱ与内皮素呈正相关。结论先天性心脏病合并肺动脉高压时,肺动脉压力达到一定程度时,血浆内皮素浓度与肾素-血管紧张素Ⅱ浓度之间呈正相关,两者之间有相互促进的作用。

Objective The study was designed to detect the Endothelin and Renin-AngiotensinⅡconcentration in plasma before and after surgery of congenital heart disease with pulmonary hypertension.The purpose of this study was to investigate the relationship of Endothelin and Renin-AngiotensinⅡ with pulmonary artery pressure,and also the relationship between Renin-AngiotensinⅡ and Endothelin.Methods The study random selected 24 patients with congenital heart disease who have be treated by surgery in the department of cardiovascular surgery of Peking University Shenzhen Hospital from May 2008 to April 2009.The subjects were divided into three groups according to their pulmonary artery systolic pressure that measured by Swan-Ganz catheter as follow： non-pulmonary hypertension group（PASP〈30mmHg）,mild pulmonary hypertension group（30mmHg〈PASP〈50mmHg）,moderate to severe pulmonary hypertension group（PASP〉50mmHg）.The concentration Renin-AngiotensinⅡ and Endothelin of plasma were measured by radioimmunoassay.Results 1.The concentration of endothelin in plasma measured by radioimmunoassay were（32.9±5.8）,（42.8±4.9）,（60.8±15.4） in non-pulmonary hypertension group,mild pulmonary hypertension group and moderate to severe pulmonary hypertension group before surgery.There were significant differences among there groups.Through correlation and regression analysis,we found out that there was a positive correlation between Endothelin and pulmonary artery pressure.2.The concentration of renin in plasma measured by radioimmunoassay were（3211.7±1241.2）,（4569.9±1155.2）,（6989.0±990.1） in non-pulmonary hypertension group,mild pulmonary hypertension group,moderate to severe pulmonary hypertension group were before surgery.There were significant differences among three groups.Through correlation and regression analysis,we found out that there was a positive correlation between Renin and pulmonary artery pressure.3.The concentration of AngiotensinⅡin plasma measured by radioimmunoassay were（44.6±12.9）,（64.1±9.9）,（69.0±10.9） in non-pulmonary hypertension group,mild pulmonary hypertension group,moderate to severe pulmonary hypertension group before surgery.There were significant differences among there groups.Through correlation and regression analysis,we found out that there was a positive correlation between angiotensinⅡ and pulmonary artery pressure.4.Through correlation and regression analysis,there was a positive correlation between rennin and endothelin,angiotensinⅡ and endothelin in moderate to severe pulmonary hypertension group.Conclusion Through our study,we found that had positive correlation between Renin-AngiotensinⅡand pulmonary artery pressure,endothelin and pulmonary artery pressure in congenital heart disease with pulmonary hypertension.Renin–Angiotensin Ⅱand Endothelin may be used as a maker for evaluating the effect of surgery of Congenital Heart Disease with pulmonary hypertension.