房间隔缺损患儿介入治疗前后肌钙蛋白Ⅰ变化的研究

Research of cardiac troponin Ⅰ release after transcatheter closure of atrial septal defect in children

目的总结并分析儿童继发孔型房间隔缺损患者接受介入封堵治疗前后肌钙蛋白Ⅰ(cTnⅠ)变化的原因及相关因素,提高临床医师对介入封堵技术治疗儿童房间隔缺损相关适应证及手术风险的了解。方法收集146例2009年9月至2012年4月在上海儿童医学中心心内科介入封堵的继发孔型房间隔缺损患儿的临床资料、辅助检查、介入封堵资料及术后随访情况。分别于介入治疗前1d、术后即刻、术后6h、术后24h、术后3d采集外周静脉血2ml,测定cTnⅠ数值,并进行对照分析。选取患儿年龄、身高、体重、体表面积、封堵器腰部直径(封堵器型号)、封堵器腰部直径与体表面积比值等指标与上述结果进行Spearman秩相关分析及Logistic多元回归分析。结果入组患儿介入术后6h及24hcTnⅠ相对术前均显著升高(术后6h cTnⅠ值对比术前,Z=-3.410,P=0.005;术后24hcTnⅠ值对比术前,Z=-1.879,P=0.012),而术后第3天cTnⅠ值与术前无统计学差异(Z=-0.332,P=0.74);Spearman秩相关分析显示所用的封堵器腰部直径越大或封堵器腰部直径与患儿体表面积比值越大,术后cTnⅠ升高幅度越大(相关系数=6.692,P=0.011);患儿手术时年龄、身高越大,术后cTnⅠ所受影响越小(年龄相关系数=-2.215,P=0.038;身高相关系数=-5.874,P=0.017)。Logistic多元回归分析显示封堵器腰部直径与患儿体表面积比值对于术后6hcTnⅠ的影响最显著(相关系数=0.31,P=0.022),而其余因素并无相关性,回归方程:cTnⅠ=-0.28+0.31×(封堵器型号/体表面积)+0.17×封堵器型号-0.13×年龄。结论经皮导管介入封堵术术后可存在一过性cTnⅠ增高或心肌损伤。只要严格掌握手术指征,介入封堵对于继发孔型房间隔缺损患儿仍是安全有效的治疗方法之一。

Objective To investigate whether transcatheter closure of atrial septal defect makes cardiac troponin I(cTnI)realease in children.Methods Clinical data,laboratory tests,imagings,diagnosis,the information of interventional therapy and postoperative follow-up from 146 children with secundum atrial septal defect who were diagnosed and get treatment of interventional were collected.The median age was(5.87±3.48)years(range,2.25-12.5)with 87 boys and 59 girls.The device size ranged from 8 to 22 mm.These patients were divided to 2 groups according to the level of cTnI after intervention.The cTnI serum concentrations were examined immediately eafter intervention,6 hours later,24 hours later and 3 days after intervention.Results The level of cTnI were normal before intervention,and the peak level of cTnI was found at 6 hours after intervention(Z=-3.410,P=0.005).All of the patients had a normal level of cTnI 3 days after operation(Z=-0.332,P=0.74).Univariate analysis showed age,height,device size,size/BSA ratio to be contributing factors for level of cTnI.The device size/body surface area ratio was identified by demonstration positive correlation with cTnI elevation by multivariate logistic regression analysis(r=0.31,P=0.022).Conclusions The transcatheter closure of atrial septal defect in children could lead to reversible increase of cTnI or induce minor myocardial lesion,the extent of which depends on the ratio of device size/body surface area.Interventional therapy of atrial septal defect is safe and effective for children.