实验性心包炎心钠素与内皮素变化及其临床意义

The changes of atrial natriuretic peptide and endothelin in experimental pericarditis and their clinical significance

目的 研究实验性心包炎心钠素 (ANP)与内皮素 (ET)的变化 ,为临床诊治小儿心包炎提供实验依据。方法 家兔 2 4只 ,随机分为实验组 1 3只 ,在心包腔内注入 30 %尿素 (2ml/kg) ;对照组 1 1只 ,在心包腔内注入生理盐水 (2ml/kg)作为对照。注射前与注射后 1、4、7、1 0、1 5与 2 1d分别测定血浆ANP与ET。注射后2 1d测定心肌中ANP与ET ,同时切取心脏作病理与电镜检查。结果 注射后 1～ 1 0d血浆ANP和ET较注射前与对照组明显增高 (P <0 .0 5) ,注射后 1 5dANP下降 ,注射后 2 1d血浆与心肌中的ANP均较注射前与对照组明显下降 (P <0 .0 1 ) ,注射后 2 1d血浆与心肌ET则显著增高 (P <0 .0 1 )。届时心包病理与电镜检查示心包增厚 ,心肌萎缩与损害。结论 心包炎早期血浆ANP与ET均升高 ,说明心功能不全处于代偿期 ,应早期切开引流 ,心包炎后期血浆ANP下降而ET持续升高表示心包已增厚 ,心肌发生萎缩与损害 ,心功能处于失偿期 ,应及时行心包大部剥脱手术 ,解除心肌束缚 。

Objective To investigate the changes of atrial natriuretic peptide (ANP) and endothelin (ET) in experimental material for diagnosis and treatment in clinical pericarditis.Methods Twenty four rabbits were randomly divided into two groups. Thirteen rabbits in groups I were injected 30 % urea into the pericardial cavity. Groups II rabbits were injected 0.9 % sodium chloride into the pericardial cavity as control.Pre injection and post injection levels of ANP and ET in the serum on days 1, 4, 7, 10, 15 and 21 were measured. On the 21st day after injection, all rabbits were killed. ANP and ET in myocardial tissues were observed under histopathological and electro microscopic sections. The levels of ANP and ET in the serum on days 1 10 after injection were higher than that on pre injection, but on the 21st day after injection, the levels of ANP in the serum were lower than that on pre injection (P<0.05). However, there was a sustained increase in the serum concentration of ET and remained at a high level on the 21st day. Cardiac damage was found under histopathological and electron microscopic sections. Conclusions The initial increase in serum concentrations of both ANP and ET suggested cardiac damage, but the cardiac function was in the complementary phase. However, subsequently, the serum concentration of ANP decreased and that of ET a sustained increase, which showed that the heart had more damage and the cardiac function was in an uncomplementary phase.