室间隔缺损自然愈合的机制和影响因素的研究进展

Research progress on the mechanism and influencing factors of spontaneous closure of ventricular septal defect

目的:总结室间隔缺损自然愈合的机制和影响因素的研究进展。方法:以“先天性心脏病”“室间隔缺损”“自然愈合”及“congenital heart disease”“ventricular septal defect”“spontaneous closure”等为中、英文关键词,在中国知网、万方数据,以及PubMed、Web of Science、Google Scholar等数据库检索2023年10月以前发表的、与室间隔缺损自然愈合机制和影响因素相关的文献,共检索到相关文献221篇。剔除内容不符、无法获取原文、证据等级较低及重复性研究的文献,最终纳入文献33篇(中文文献5篇、英文文献28篇),进行分析总结。结果:室间隔缺损自然愈合的主要机制包含膜部瘤的形成、心肌细胞和纤维组织的增生等,主动脉瓣脱垂对自然愈合的作用仍存在争议。影响室间隔缺损自然愈合的因素较多,包括患儿的年龄、缺损大小、缺损部位、染色体核型异常、血红蛋白浓度与营养状况、尿激酶型纤溶酶原激活物等,但个体差异大。结论:目前室间隔缺损自然愈合的机制尚不明确,其在分子水平的愈合机制还缺乏相关研究;影响室间隔缺损自然愈合的因素较多,但个体差异大,目前仍未达成共识。关于室间隔缺损自然愈合的机制及影响因素还有待进一步深入研究。

Objective This study aimed to summarize the research progress on the mechanisms and influencing factors of the spontaneous closure of ventricular septal defect(VSD).Methods Chinese and English databases such as CNKI,Wanfang,and PubMed,Web of Science,Google Scholar were searched using the following Chinese and English keywords:"先天性心脏病""室间隔缺损""自然愈合"and"congenital heart disease""ventricular septal defect""spontaneous closure"in 221 articles on the mechanisms and influencing factors of the spontaneous closure of VSD published before October 2023.Articles with inconsistent content and had no available full text,low level of evidence,and reproducibility were excluded.Finally,33 studies(5 in Chinese and 28 in English)were included for summary and analysis.Results The mechanisms underlying the spontaneous closure of ventricular septal defect are associated with the formation of membranous aneurysm and the proliferation of myocardial fibrous tissues.The effect of aortic valve prolapse remains unclear.The factors influencing this spontaneous closure include age,defect size,defect location,chromosome karyotype abnormality,hemoglobin concentration and nutritional status,and urokinase-type plasminogen activator.However,individual differences are large Conclusion At present,the mechanism underlying the spontaneous closure of VSD is still unclear,and related molecular studies are lacking.Many factors influence the spontaneous closure of VSD,but the individual differences are large so no consensus has been reached.The mechanism and influencing factors of the spontaneous closure of VSD remain to be further studied.