肾上腺髓质素在先天性心脏病患儿合并心力衰竭时的变化及意义

Changes of plasma adrenomedullin in children with congenital heart disease combined with heart failure and their clinical implication

目的探讨先天性心脏病(CHD)合并心力衰竭(HF)患儿血浆肾上腺髓质素(adrenomedul-lin,ADM)水平的变化规律,分析ADM与HF严重程度的关系,研究ADM对婴幼儿HF诊断、心功能分级和疗效监测的临床意义以及在心功能评估中的价值。方法选取2014年6月至2016年4月CHD住院患儿46例,根据Ross分级标准将其分成轻、中、重度3组:轻度HF组16例、中度HF组18例、重度HF组12例,选取同期25例健康儿童作为对照组。应用放射免疫分析法(RIA)测定血浆ADM浓度,应用ELISA法测定血浆NT-pro BNP浓度,同时检查左室射血分数(LVEF)、二尖瓣舒张早期流速峰值/二尖瓣舒张晚期流速峰值(E/A),分析HF患儿血浆ADM浓度与HF严重程度及LVEF、E/A的相关性。结果心力衰竭各组患儿血浆ADM浓度与心力衰竭严重程度分析存在相关性,HF程度越重,血浆ADM水平升高越显著,呈明显正相关(r=0.65,P<0.01),重度心力衰竭组患儿ADM浓度明显高于轻度和中度心力衰竭组(P<0.01),轻度心力衰竭组高于对照组(P<0.05),血浆ADM水平与LVEF呈负相关(r=-1.05,P<0.01)。结论血浆ADM水平检测对先天性心脏病合并心力衰竭患儿诊断、心功能评估和预后判断等方面具有重要临床意义。

Objective To explore the changes of plasma level of adrenomedullin(ADM)in congenitalheart disease patients with heart failure,analyze the relationship between ADM and the severity of heart failure,assess the value of plasma ADM in the diagnosis of CHF and evaluate the cardiac function in pediatric patients withcongenital heart disease. Methods 46 patients with CHD were enrolled according to the modified Ross Score.They were divided into three groups:mild CHF group(n = 16)and moderate CHF group(n = 18)and severeCHF group(n = 12). 25 matched normal children were enrolled as controls. Plasma ADM was measured withradioimmunoassay(RIA)and the contents of NT-pro BNP were determined among all the patients. LVEF and E/Ain all of them were also detected. The relationship between plasma ADM level and modified Ross Score andechocardiographic cardiac functional indexes was analyzed. Results Plasma ADM was positively correlated withmodified Ross Score(r = 0.65,P < 0.01). Plasma ADM concentration in the severe CHF group was significantlyhigher than that of mild and moderate CHF group(P < 0.01),and plasma ADM concentration in the mild CHFgroup was higher than that in the control group(P < 0.05). Plasma ADM was negatively correlated with LVEF andE/A(r =-1.05,P < 0.01). Conclusion Plasma ADM level could be used to assess cardiac function and diag-nose CHF with CHD.