小儿主动脉缩窄血压 血清可溶性E-选择素变化及其意义研究

Changes of blood pressure and soluble E-selectin in serum in children with coarctation of aorta and their clinical significances

目的监测主动脉缩窄患儿术前及术后近、中期的血压及血清可溶性E-选择素的水平,并探讨其意义。方法 2010年1月至2010年10月在广州市妇女儿童医疗中心心脏中心行主动脉缩窄矫治术的患儿共23例,选取20例作为主动脉缩窄组(Co A组),其中单纯性主动脉缩窄6例,复合性主动脉缩窄(合并其他心内畸形)14例;同期选择20例单纯室间隔缺损患儿(VSD组)进行对照,均于术前1 d、术后1个月、6个月、1年测量血压、血清可溶性E-选择素水平,并同期选取20名健康儿童(健康组)进行对照。3组儿童在年龄、性别、体重指数、血清甘油三脂水平差异无统计学意义。结果除术前1 d Co A组右下肢血压低于健康组外,Co A组、VSD组的右上肢、右下肢血压均与同时期的健康组差异无统计学意义(P>0.05),且3组儿童均无高血压表现。Co A组术前1 d、术后1个月、术后6个月、术后1年血清可溶性E-选择素均明显高于同时期的健康组(P<0.01),而VSD组和健康组差异无统计学意义(P>0.05)。Co A组在不同时期测定的血清可溶性E-选择素水平差异无统计学意义,此与VSD组、健康组的结果相仿(P>0.05)。同时期的单纯Co A组与复合Co A组的血清可溶性E-选择素差异无统计学意义(P>0.05)。结论血管内皮功能的损害持续存在,可能与主动脉缩窄矫治术后远期心血管并发症有关,合并其他心内畸形并未加重主动脉缩窄内皮损害的程度,对主动脉缩窄矫治术后患者进行长期随访至关重要。

Objective To monitor blood pressure and level of soluble E-selectin in serum in children before operation and in the short-and mid-term follow-up after operation, and to explore their clinical significances. Methods Twenty-three children who underwent successful surgery for aortic coarctation between January 2010 and October 2010 in Guangzhou Women and Children＇s Medical Center were enrolled in the study. There were 6 patients with isolated CoA, and 14 patients with CoA associated with other heart malformations （CoA group）. Meanwhile 20 patients with isolated ventricular septal defect （VSD） were selected as VSD group. Another 20 healthy children with normal echocardiographic findings was observed. Blood pressure and soluble E-selectin in serum were measured in all subjects at 1 day prior to operation （or blank treatment） and at 1 month, 6 months and 1 year of follow-up, respectively. There was no statistical difference in age, gender, BMI or tri- glyceride in serum among three groups. Results Hypertension at rest was not found in all children in different periods. Except that right lower limb blood pressure in CoA group before operation was lower than that in the healthy group, right upper limb blood pressure and right lower limb blood pressure in CoA group and VSD group were similar those of the healthy group in the same period. In the same period, soluble E-selectin in serum in CoA group was significantly elevated compared to healthy group （ P 〈 0.01 ）, but VSD group was similar to healthy group （ P 〉 0.05）. There was no statistical change in soluble E-selectin in serum at 1 year of follow-up in CoA group compared to that before operation, and so it was similar with VSD group and healthy group （P 〉 0.05）. Soluble E-selectin level in serum in isolated CoA was similar to that in CoA associated with other heart malformation （P 〉 0.05）. Conclusion Endothelial damage may be persistent, which is probably associatedwith the long-term cardiovascular complications after operation for CoA, but endothelial damage in CoA associated with other heart malformation is not worse than isolated CoA. A long period of follow-up is necessary.