半胱氨酸蛋白酶抑制剂C在小儿先天性心脏病肺动脉高压中作用的探讨

Effect of cysteine protease inhibitor Conpulmonary hypertension in children with congenital heart disease

目的探讨先天性心脏病(CHD)合并肺动脉高压(PH)患儿手术前后半胱氨酸蛋白酶抑制剂C(Cystatin C,CysC)水平的变化及意义。方法将80例先天性心脏病患儿按其肺动脉收缩压(pulmonary arterial systolic pressure,PASP)分为无PH组,轻度PH组,中度PH组,重度PH组。测定各组术前、术后即刻、术后24h Cys C在血清中的含量,比较手术前后的变化,分析其与肺动脉压力及早期预后的关系。结果术后各组血清Cys C含量先升高后降低,与术前相比差异显著(P <0.05)。三个时点血清Cys C含量各组间均有显著性差异(P <0.05),其含量与肺动脉高压的程度(r=0.895, P <0.05; r=0.874, P <0.05; r=0.873,P <0.05)和重症监护室滞留时间(r=0.35, P <0.05; r=0.389, P <0.05; r=0.41, P <0.05)呈正相关,且血清Cys C含量随着肺动脉压力的增高而增高。结论血清Cys C含量与肺动脉高压程度、重症监护室滞留时间明显相关,据此可推断Cys C在先天性心脏病患儿肺动脉高压的形成中发挥一定的作用,可作为衡量肺动脉高压程度和早期预后的相关指标。

Objective To investigate the perioperative changes and its signifcance of cystatin C(Cys C) level among children with congenital heart disease(CHD) combined with pulmonary hypertension(PH) before and after operation. Methods 80 children with congenital heart disease were divided into no PH group, mild PH group, moderate PH group and severe PH group according to their pulmonary systolic blood pressure(pulmonary arterial systolic pressure,PASP). The contents of Cys C in serum were measured before,immediately after operation and 24 hours after operation. The changes before and after operation were compared, and the relationship between Cys C and pulmonary artery pressure and early prognosis was analyzed. Results The level of serum Cys C increased first and then decreased after operation, which was significantly different from that before operation(P< 0.05). There was significant difference in serum Cys C content among three groups at three time points(P < 0.05), and its content and the degree of pulmonary hypertension were0.895(P < 0.05), 0.874(P < 0.05). There was a positive correlation between the length of stay in intensive care unit(r = 0.35, P < 0.05;r = 0.389, P < 0.05;r = 0.41, P < 0.05), and the level of serum Cys C increased with the increase of pulmonary artery pressure.Conclusion The level of serum Cys C was significantly correlated with the degree of pulmonary hypertension and the retention time of intensive care unit. It can be concluded that Cys C may play a role in the formation of pulmonary hypertension in children with congenital heart disease. It can be used as an index to measure the degree of pulmonary hypertension and early prognosis.