动脉导管未闭患儿介入封堵术前后血清醛固酮变化与心肌重塑的关系

Changes of the serum aldosterone and its relationship with cardiac remodeling in children with patent ductus arteriosus before and after interventional therapy

目的观察动脉导管未闭(PDA)患儿介入封堵术前后血清醛固酮(ALD)的变化,探讨其与心肌重塑的关系及临床意义。方法连续监测PDA患儿介入封堵术前及术后24 h、1个月、3个月平卧位血清ALD水平、左心房室腔径及心功能指标,分析血清ALD与左心房室腔径、心功能指标的关系。结果 PDA患儿介入封堵术前及术后24 h、1个月、3个月时,血清ALD水平[(348.44±54.27)pmol/L比(311.35±50.34)pmol/L比(258.14±50.56)pmol/L比(199.09±48.12)pmol/L,F=18.98,P<0.05]、左心房内径指数(LADI)[(42.33±6.44)mm/m^2比(36.22±5.33)mm/m^2比(35.54±5.36)mm/m^2比(34.26±4.32)mm/m^2,F=12.18,P<0.05]、左心室舒张末期前后径指数(LVEDDI)[(69.34±7.43)mm/m^2比(67.43±6.33)mm/m^2比(66.35±6.56)mm/m^2比(60.54±5.34)mm/m^2,F=11.71,P<0.05]、左心室收缩末期前后径指数(LVESDI)[(39.43±8.32)mm/m^2比(38.47±7.45)mm/m^2比(36.85±5.43)mm/m^2比(35.63±5.34)mm/m^2,F=13.13,P<0.05]、左心室射血分数(LVEF)[(73.87±6.53)%比(67.34±4.53)%比(70.75±5.24)%比(70.43±4.34)%,F=12.09,P<0.05]及左心室短轴缩短率(LVFS)[(41.54±5.36)%比(37.53±5.27)%比(38.15±5.75)%比(38.98±5.28)%,F=12.01,P<0.05]四组比较,差异均有统计学意义。血清ALD、LADI及LVEDDI介入封堵术后24 h、1个月、3个月的水平均较术前降低,差异均有统计学意义。介入封堵术后1个月[(36.85±5.43)mm/m^2比(39.43±8.32)mm/m^2,P<0.05]和3个月[(35.63±5.34)mm/m^2比(39.43±8.32)mm/m^2,P<0.05]LVESDI的水平均较术前降低,差异均有统计学意义;其介入封堵术后24 h的水平与术前比较[(38.47±7.45)mm/m^2比(39.43±8.32)mm/m^2,P>0.05],差异无统计学意义。介入封堵术后1个月[(70.75±5.24)%比(67.34±4.53)%,P<0.05]、3个月[(70.43±4.34)%比(67.34±4.53)%,P<0.05]LVEF的水平均高于介入封堵术后24 h,差异均有统计学意义,介入封堵术后24 h[(67.34±4.53)%比(73.87±6.53)%,P<0.05]LVEF水平低于介入封堵术前,差异有统计学意义。介入封堵术后1个月[(38.15±5.75)%比(37.53±5.27)%,P<0.05]、3个月[(38.98±5.28)%比(37.53±5.27)%,P<0.05]LVFS的水平均高于介入封堵术后24 h,差异均有统计学意义,介入封堵术后24 h[(37.53±5.27)%比(41.54±5.36)%,P<0.05]LVFS水平低于介入封堵术前,差异有统计学意义。Pearson相关分析显示,PDA患儿血清ALD水平与LADI、LVEDDI及BLVESDI具有相关性(均P<0.05)。结论 PDA患儿存在ALD分泌激活及慢性心力衰竭,早期介入封堵治疗可逆转ALD的分泌激活及心肌重塑。

Objective To observe the changes of serum aldosterone（ALD） in children with patent ductus arteriosus（PDA） at before and af ter interventional therapy, and explore its relationship with cardiac remodeling and its clinical signif icance. Methods Serum ALD level taken in supine position, lef t heart chambers sizes and heart f unction in children with PDA were measured and compared before,24 hours part intervention and at 1 month and 3 months af ter. The relationship between ALD and the lef t heart chambers sizes and the heart f unction were analyzed. Results Serum ALD levels were significantly lower 24 hours, 1 month and 3 months than the pre-procedure levels [（348.44±54.27）pmol/L vs.（311.35±50.34）pmol/L vs.（258.14±50.56）pmol/L vs.（199.09±48.12）pmol/L, F=18.98, P 〈0.05]. The left atrial diameter indexes[（42.33±6.44）mm/m2 vs.（36.22±5.33）mm/m2 vs.（35.54±5.36）mm/m2 vs.（34.26±4.32）mm/m2,F=12.18, P〈 0.05] and the left ventricular end diastolic diameter indexes [（69.34±7.43）mm/m2 vs.（67.43±6.33）mm/m2 vs.（66.35±6.56）mm/m2 vs.（60.54±5.34）mm/m2, F=11.71, P 〈0.05]were also lower at 24 hours, 1 month and 3 months af ter intervention than pre-proced ure measurements. The lef t ventricular end systolic diameter indexes measured at 24 hours,1 mouth and 3 mouths af ter intervention were all lower as compared to pre-procedure condition [（39.43±8.32）mm/m2 vs.（38.47±7.45）mm/m2 vs.（36.85±5.43）mm/m2 vs.（35.63±5.34）mm/m2, F=13.13, P〈 0.05]. There was relevance between the serum ALD level and the lef t heart chamber size indexes（P 〈 0.05）. Conclusions Early interventional therapy for PDA can reverse the activation of aldosterone secretion and cardiac remodeling.