先天性心脏病患儿手术前后血内皮素-1和一氧化氮的浓度变化

Pre-and postoperative changes of plasma endothelin-1 and serum nitric oxide concentration in patients with congenital heart diseases(CHD)

目的 :观察先天性心脏病 (简称先心 )伴肺动脉高压 (PH)患儿手术前后血浆内皮素 1(ET 1)和血清一氧化氮 (NO)的浓度变化。方法 :31例先心患儿分为中重度PH组 (10例 )、轻度PH组 (11例 )和无PH组(10例 ) ,分别用放射免疫法和硝酸还原酶法测定术前、术后即刻、术后 4h、2 4h血浆ET 1及血清NO浓度。另选取无心肺疾患的普通住院患儿 10例作为对照组。结果 :术前先心伴PH患儿血浆ET 1水平明显高于先心无PH者 (P <0 .0 1) ,而血清NO浓度明显低于先心无PH者 (P <0 .0 5 ) ;先心患儿术前血浆ET 1浓度与血清NO水平呈负相关 (r=- 0 .4 5 1,P <0 .0 5 )。先心患儿术后血浆ET 1明显升高 ,术后 4h最明显 ,术后 2 4h已缓慢下降 ;NO水平则于手术后下降 ,尤其以术后 4h下降最为显著 ,术后 2 4h ,则有所回升 ,以无PH恢复最快。结论 :ET/NO失衡可能参与了肺动脉高压的发生、发展过程。

Objective:To investigate the pre- and postoperative changes of blood ET-1 and NO concentrations in patients with CHD.Methods:Blood ET-1 and NO concentrations were assayed at pre-operation and at 0,4 and 24 hours after operation in 31 cases with CHD:10 cases had mode rate or severe pulmonary hypertension(group A) and 11 cases had slight pulmonary hypertension(group B),the other 10 cases had normal pressure(group C);and 10 cases of the control group were enrolled in the study.Results:Plasma ET-1 concentrations in group A and group B were significantly higher than that of group C(P<0.01). On the contrary,serum NO concentrations in group A and B were significantly lower than that of group C(P<0.05). In the three group,at 4 hours after operation,the concentration of ET-1 was significantly higher than that of pre-operation(P<0.01). At 24 hours after operation,the plasma ET-1 concentration of group C has returned to the level of pre-operation(P>0.05),but in group A and group B,the ET-1 concentration was still higher than that of pre-operation(P<0.05). On the contrary,at 4 hours after operation the serum NO level was lower than that of pre-operation in three groups(P<0.01). At 24 hours after operation,the NO concentration of group C has no significant difference compared with that of pre-operation(P>0.05). But in group A and B,the NO level was still lower than that of pre-operation(P<0.01). And plasma ET-1 concentration had a negative linear correlation with serum NO concentration(r=-0.451,P<0.05).Conclusion:The imbalance of ET/NO may have an important role in the pathogenesis of PH.