新生儿心力衰竭时血浆内皮素、降钙素基因相关肽和心钠素的变化及其临床意义

Endothelin-1,calcitonin gene-related peptide and atrial natriuretic factor in neonatal heart failure

目的 了解血浆内皮素 (ET 1)、降钙素基因相关肽 (CGRP)和心钠素 (ANF)在新生儿心力衰竭时的作用和地位。方法 放射性同位素免疫分析法直接测定 2 8例心力衰竭新生儿不同病程时血浆中ET 1、CGRP和ANF含量 ,并与 2 0例正常新生儿对比。结果 心衰发生时ET 1、CGRP、ET 1/CGRP、ET 1/ANF均明显高于对照组 (P <0 0 1、P <0 0 5、P <0 0 1、P <0 0 1) ,ANF水平两组间无明显差异 (P >0 0 5 ) ;心衰纠正后 ,ET 1水平迅速下降 ,而CGRP和ANF水平则持续增长 ,ET 1/CGRP、ET 1/ANF明显降低 (P <0 0 1、P <0 0 1) ,至 3～ 4天方逐渐恢复正常 ;死亡患儿临终前ET 1、ET 1/CGRP、ET 1/ANF维持在高水平。而CGRP、ANF则均处于较低水平。结论 ET 1、CGRP和ANF等均可能与新生儿心力衰竭的病理机制有关 ,其水平的动态变化可作为判断临床转归的重要参考指标。

Objective To determine the effects of endothelin-1(ET-1),calcitonin gene-related peptide (CGRP) and atrial natriuretic factor (ANF) in physiopathology of neonatal heart failure.Methods ET-1, CGRP and ANF in the serums of 28 neonates with heart failure (HF) were continuously measured by radioimmunology and compared with 20 normal neonates.Results HF neonates had higher levels of ET-1,CGRP,ET-1/CGRP and ET-1/ANF than those of normal infants.When heart failure were controlled,serum levels of ET-1 decreased quicklly with increase of levels of CGRP and ANF.Conclusion Our work indicated that all of ET-1, CGRP and ANF play important roles in the pathologic development of neonatal heart failure.Otherwise,we thought that the effects of ET-1 might be primary and the changes of CGRP and ANF were related to ET-1.All of ET-1,CGRP and ANF are useful indicators in outcome of neonatal heart failure.