血浆心钠素水平在反映房间隔缺损、室间隔缺损和动脉导管未闭患儿介入封堵术后心脏结构及心功能变化中的价值分析

Plasma atrial natriuretic peptide level in reflecting changes in cardiac structure and function after intervention closure of atrial septal defect, ventricular septal defect and patent ductus arteriosus in children

目的观察房间隔缺损(ASD)、室间隔缺损(VSD)以及动脉导管未闭(PDA)患儿介入封堵术后血浆中心钠素(ANP)的水平,分析血浆中ANP的水平在反映ASD、VSD和PDA患儿介入封堵术后心脏结构及心功能变化中的价值。方法该院60例先天性心脏病患儿为CHD组,分别于介入封堵术的前1天、术后第3天、术后1个月和术后3个月进行超声心动图检查右心室功能,并采用酶联免疫法检测其血浆中ANP的表达水平;另选择健康体检儿童30例,设为正常对照组(NC组),并作相关检查。结果酶联免疫吸附双抗体夹心法测定血浆中ANP表达水平显示,与NC组相比,术前1天、术后第3天和1个月时,各组患儿ANP水平均有不同程度的升高(P<0.05和P<0.01),术后3个月则趋于稳定,与NC组相比,差异无统计学意义;与术前1天相比,所有患儿封堵术后第3天血浆ANP水平明显减低(P<0.05),且术后1和3个月进一步降低(P<0.01)。超声心动图检查发现,与NC组相比,术前1天、术后第3天和术后1个月时,患儿舒张末期右心室容积、收缩末期右心室容积及右心室射血分数均有显著升高(P<0.05和P<0.01);术后3个月,各项指标趋于稳定,与NC组相比,差异无统计学意义;与术前1天相比,术后第3天右心室舒张末期容积、右心室收缩末期容积、射血分数均有明显减低(P<0.05);术后3和6个月后,右心室舒张及收缩末期容积及射血分数较术前明显下降(P<0.01)。结论介入封堵术后,检测ASD、VSD和PDA患儿血浆中ANP的水平,有助于评估患儿心脏结构及心功能的恢复情况。

【Objective】To observe the postoperative plasma level of atrial natriuretic peptide（ANP） in children with atrial septal defect（ASD）, ventricular septal defect（VSD） and patent ductus arteriosus（PDA）, and to analyze the plasma level of ANP in reflection of postoperative cardiac structure and function after intervention closure of ASD,VSD and PDA in children. 【Methods】A total of 60 children with congenital heart diseases were selected from our hospital into CHD group. The right ventricular（rv） function was checked by echocardiography and the expression level of ANP in plasma was detected with double antibody enzyme-linked immunosorbent clamp assay 1 d before the interventional closure, 3 d, 1 m and 3 m after the intervention surgery. Meanwhile 30 cases of healthy check-up were selected into normal control group（NC group） and had all the relevant examinations. 【Results】The plasma ANP level in the CHD group increased 1 d before, 3 d, 1 m after surgery compared with that of the NC group（P 0.05 and P 0.01）, but it became stable 3 m after operation without significant difference from that in the NC group. The plasma ANP level in the CHD group significantly lowered 3 d after surgery compared with that 1 d before operation（P 0.05）, and further reduced 1 m and 3 m after operation（P 0.01）. Echocardiography revealed that the right ventricular end-diastolic volume, right ventricular end-systolic volume and right ventricular ejection fraction of the CHD group 1 d before operation, 3 d and 1 m after operation were significantly higher than those of the NC group（P 0.05 and P 0.01）. The cardiac indicators tended to be stable in the CHD group 3 m after operation with no significant differences from those in the NC group. The right ventricular end-diastolic volume, right ventricular end-systolic volume and ejection fraction were significantly reduced 3 d after operation compared with those 1 d before operation（P 0.05）. The right ventricular end-diastolic and end-systolic volume and ejection fraction significantly decreased 3 m and 6 m after operation compared with the preoperative ones（P 0.01）. 【Conclusions】Detection of plasma ANP level in ASD, VSD and PDA children helps to assess the recovery of their cardiac structure and function after interventional closure.