肺多血型先天性心脏病介入前后血浆硫化氢、内皮素-1、降钙素基因相关肽变化的临床意义

Changes of Plasma H_2S,ET,and CGRP Levels in Congenital Heart Disease Combined with Pulmonary Arterial Hypertension After Transcathete Closure

目的:探讨血浆硫化氢(H2S)、内皮素(ET-1)、降钙素基因相关肽(CGRP)在肺多血型先天性心脏病(先心病,CHD)围手术期的变化及其临床意义。方法:选取健康体检儿20例为对照组(A组),CHD无肺动脉高压(PH)组[B组,肺动脉收缩压(SPAP)<30mmHg]25例,轻度PH组(C组,SPAP 30-49mmHg)25例,中、重度PH组(D组,SPAP≥50mmHg)18例。测量CHD组患儿术前1d、术后2d和对照组儿童血浆H2S、ET-1、CGRP浓度,比较不同组患儿手术前后血浆各因子浓度的变化及与SPAP、PP/PS、QP/QS等之间的关系。结果:血浆H2S浓度在CHD组较对照组、PH组较无PH组、D组较C组均降低,不同程度PH组中血浆H2S的浓度随着SPAP的升高而降低;术后早期不同程度PH组间血浆H2S浓度仍存在差异(P<0.05);血浆H2S与SPAP、PP/PS、QP/QS均呈负相关(︱r︱>0.63)。CHD患儿较对照组血浆ET-1明显升高,而CGRP水平明显降低;随着SPAP的升高,ET-1水平升高得越明显,CGRP下降得越明显;术后早期,血浆ET-1水平降低,血浆CGRP水平升高,但不同程度PH组之间仍存在差异(P<0.05);血浆ET-1与CGRP水平有良好的相关性(r=-0.641);ET-1与SPAP呈正性相关,CGRP与之呈负性相关,ET-1/CGRP比值与SPAP、QP/QS亦呈正性相关(r=0.74、0.536,P<0.05)。结论:H2S/CSE体系、ET-1/CGRP体系在PH的发生发展中具有重要作用,两者相互作用,动态调节平衡。在CHD合并PH早期,及时纠正异常血流动力学后大多恢复良好。

Objective：To explore the levels change of plasma H2S,ET-1, and CGRP on pulmonary hy- pertension（PH） in congenital heart disease（CHD） children in perioperative period. Methods： Twenty healthy children were randomly selected as control group （group A）, 25 children with CHD and normal systolic pulmonary arterial pressure （SPAP） as group B,25 children with CHD and mild PH as group C,18 children with CHD and moderate to severe PH as group D. The plas- ma H2S, ET-1, and CGRP were measured in CHD children in different groups before and after catheterization, to analyze their connection with SPAP, PP/Ps,and QP/Qs. Results. The level of plasma H2S were lower in CHD group than group A, PH group than non-PH group, group D than group C, H2S is reduced by increasing SPAP in different groups; differences remained in groups after early postoperative; the level of H2S were positively correlated with the SPAP, Pp/ Ps, QP/Qs（ ｜ r ｜ 〉0.63）. The level of plasma ET-1 in CHD children was higher than group A, but CGRP was significantly reduced. The level of ET-1 was increased, CGRP decreased in pace with SPAP increasing; plasma ET-1 was reduced after postoperative, CGRP was elevated, but differences still exist; plasma ET-1 and CGRP have a good correlation （r= -0. 641） ; ET-1 was positively correlated with SPAP, CGRP was negatively correlated ; the ratio of ET-1/CGRP was also positively correlated with SPAP and QP/Qs. Conclusion： The system of H2 S/CSE and ET-1/ CGRP plays an important role in the development of PAH, interacts and dynamically adjusts to the balance. Pulmonary vascular function could recover well under the reversible pulmonary hy- pertension with oromlotly correcting the abnormal hemodvnamics.