先天性心脏病患儿血浆内皮素-1变化及其临床意义的研究

CHANGES AND INFLUENCING FACTORS OF PLASMA ENDOTHELIN CONCENTRATIONS IN CHILDREN ASSOCIATED WITH CONGENITAL HEART DEFECTS

目的 :研究先天性心脏病 (CHD)患儿血浆内皮素 - 1(ET 1)浓度的变化 ,分析各种因素对ET 1浓度的影响 ,探讨CHD患儿血浆ET 1水平变化的机制和意义。方法 :对照组 :30例。观察组 :97例CHD患儿 ,其中肺充血组 69例 ,肺缺血组 2 8例 ;肺充血伴肺动脉高压 (肺高压 ,PH) 50例 ,不伴PH19例。用放免法直接测定每例静脉血中ET 1含量。结果 :①左向右分流的CHD患儿血浆ET 1浓度明显增加 ,达正常对照约 2 5倍 ,在PH形成之前ET 1浓度已经升高 ,达正常对照约 1 5倍 ;②PH病人ET 1含量增高且随肺动脉压的升高而增高 ;③心脏扩大对血浆ET 1浓度无影响 ;④前列腺素E1( 2 0～ 4 0ng·kg- 1·min- 1)可降低肺高压患儿血浆ET 1水平。结论 :肺血流量增加是ET 1生成增多的主要原因 ;ET 1可引起肺高压 ,肺高压可促进ET 1的产生 ,PGE1可延缓PH的形成和发展。

Objective:The present study was to make sure how the plasma ET 1 levels changed in congenital heart defects(CHD)patients and search for the mechanism and significance of the changes in ET 1 concentrations through comparing various influencing factors of ET 1 levels. Methods:Control group:30 healthy children.Observation group:Selected 97 CHD patients including 69 pulmonary congestive CHD patients and 28 pulmonary ischemic CHD patients.Their plasma ET 1 concentrations were measured by radioimmunoassay.Results:CHD patients with left to right shunts and increased pulmonary blood flow had elevated peripheral venous endothelin-1 concentrations in contrast with normal subjects;Pulmonary hypertension(PH) associated with CHD patients had higher ET 1 levels than those without PH patients and the severer the PH was,the higher the ET 1 concentrations were.Enlargement of the heart size could not increase the plasma ET 1 levels;Intravenous PGE 1 treatment can decrease the plasma ET 1 concentrations.Conclusion:Increased pulmonary blood flow is the main cause of raised ET 1 levels in CHD patients;ET 1 can cause PH,but PH can accelerate the production of ET 1,ET 1 antagonist might retard the development of PH.