介入治疗对动脉导管未闭患儿心肌的影响

Effect of Transcatheter Theraphy on Myocardium for Patent Ductus Arteriosus

目的研究PDA介入治疗是否会导致心肌损伤和炎性反应,分析介入治疗致心肌损伤的影响因素。方法选取2008年10月-2010年8月在本院住院的37例PDA患儿。于术前,术后即刻,术后4 h、2 d、3 d、7 d,采集静脉血,应用ELISA法检测其血清心肌肌钙蛋白I(cTnI)和CRP水平,并记录年龄、缺损大小、曝光时间和造影剂量等相关危险因素。应用SPSS 13.0软件进行统计学处理。结果 PDA介入治疗术后即刻、4 h、2 d和3 d cTnI水平分别为0.08(0.00～1.37)μg.L-1、0.09(0.00～0.68)μg.L-1、0.06(0.00～0.96)μg.L-1及0.04(0.00～0.96)μg.L-1,较术前[0.05(0.00～0.58)μg.L-1]升高;术后7 d[0.04(0.00～0.44)μg.L-1]已低于术前水平,高峰出现在术后4 h,与术前cTnI水平比较差异有统计学意义(P<0.05);术后各时段cTnI均低于正常水平。于术后4 h CRP[0.36(0.00～28.00)mg.L-1]开始升高,至术后3 d达峰值[7.79(0.20～52.40)mg.L-1],继之下降;与术前[0.30(0.00～17.06)]相比,术后3 d及7 d CRP水平[4.10(0.20～34.57)mg.L-1]均显著升高(Pa<0.05);术后各时段CRP均低于正常水平。年龄、曝光时间、缺损大小和造影剂量等与cTnI变化无明显相关性。结论 PDA介入治疗未引起明显心肌损伤及炎性反应,是一种安全的治疗手段。

Objective To study whether the transcathete theraphy for patent ductus arteriosus （PDA） an cause myocardial injury and inflammatory reaction, and to analyze the influencing factors on myocardial injury. Methods The blood samples were collected （basal, immediate post procedure, at 4 h ,2 d,3 d and 7 d post procedure）, from 37 consecutive patients with PDA,who were hospitalized in Anhui Provincial Children＇s Hospital from Oct. 2008 to Aug. 2010. The levels of cardiac troponin I（cTnI） and C reactive protein（CRP） were detected by enzyme linked immunosorbent assay. The related risk factors （age, the size of defect, duration of exposition and dose of contrast agent） were sought. The statistical analysis of the results were performed by SPSS 13.0 software. Results The cTnI levels at immediate post procedure, 4 h,2 d and3 d were0.08（0.00-1.37） μg . L-1,0.09（0.00-0.68） μg . L -1,0.06（0.00-0.96） μg .L-1 and0.04（0.00-0.96） μg . L- 1 , which were higher than that before procedure [ 0.05 （0.00 - 0.58 ） μg . L - l ]. The cTnI level at 7 d was lower than that before procedure. The peak levels of cTnI occurred at 4 h post procedure and the elevation of cTnI was significant（ P 〈 0.05 ）. All the cTnl levels post procedure were lower than normal level in children. The CRP levels began to ascend at 4 h [ 0.36 （ 0.00 - 28.00 ）mg . L - 1] after the procedure, and reached peak levels at 3 d post procedure,then decreased. The CRP levels at 3 d and 7 d post procedure were higher than that before procedure and the differences were significant（ Pa 〈 0.05 ）. The cTnI levels at post procedure weren＇t significantly correlated with age; duration of exposure, size of defect and dose of contrast material. Conclusions Transcatheter closure of PDA is safe and effective without causing obvious myocardial injury and inflammatorv reaction.