心房利钠肽、内皮素-1、血管性假血友病因子在西地那非治疗新生儿持续性肺动脉高压过程中的变化及意义

目的探讨血浆心房利钠肽（ANP）、内皮素（ET）-1、血管性假血友病因子（vWF）水平在西地那非治疗新生儿持续性肺动脉高压（PPHN）过程中的变化及意义。方法选取PPHN患儿66例（PPHN组）应用西地那非治疗，分别于治疗前和治疗3、7d后采用彩色多普勒超声测定肺动脉收缩压（PASP），并同时检测动脉血气和右手指脉搏血氧饱和度（SpO2），再同时采集静脉血应用酶联免疫吸附法检测ANP、ET-1和vWF水平。各指标与除外心肺相关疾病的非PPHN患儿40例（对照组）进行比较。结果PPHN组治疗前PASP、SpO2、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO，）及血浆ANP、ET-1、vWF水平[（66．5±13.4）mmHg（1mm Hg=0．133kPa）、0．726±0．531、（46．3±7．2）mmHg、（59．2±7．4）mmHg、（272．6±20．3）ng／L、（221．3±24．3）ng／L、（142．5±20．3）％]与对照组[（25．0±6．2）mmHg、0．896±0．767、（88．3±7．6）mmHg、（41．1±6．1）mmHg、（68．4±7．9）ng／L、（39．8±6．5）ng／L、（95．3±18．5）％]比较差异有统计学意义（P〈0．05）；PPHN组治疗3d后各指标[（48．3±3．2）himHg、0．841±0．416、（73．6±9．3）mmHg、（50．5±7．2）InmHg、（102．6±20．3）ng／L、（79．6±15．2）ng/L、（103．6±14．1）％]均明显改善，与治疗前和对照组比较差异有统计学意义（P〈0．05），治疗7d后各指标[（25．2±3．6）mmHg、0．882±0．724、（85．4±7．4）mmHg、（40．2±6．4）mmHg、（64．4±3．6）ng/L、（37．3±5．4）ng/L、（92．9±11．7）％]均较治疗3d后明显改善，差异有统计学意义（P〈0．05），与对照组比较差异无统计学意义（P〉0．05）。直线相关分析结果显示，治疗前及治疗3、7d后ANP、ET-1、vWF与PASP、PaCO2分别呈显著正相关（P〈0．01），ANP、ET-1、vWF与SpO2、PaO2分别呈显著负相关（P〈0．01）。以心脏超声监测PASP为标准做受试者工作特征曲线，ANP、ET-1、vWF评价西地那非疗效的灵敏度分别为82．2％、86．4％、85．1％，特异度分别为83．4％、87．6％、84．7％。结论ANP、ET-1、vWF可能在西地那非有效治疗PPHN的机制中起重要作用，适时检测PPHN新生儿血浆ANP、ET-1、vwF水平可客观评价西地那非对PPHN的疗效。

The clinical value of atrial natriuretic peptide,endothelin-1 and yon Willebrand factor in newborns with persistent pulmonary hypertension after the treatment of sildenafil

Objective To study the changes and significance of plasma atrial natriuretic peptide （ANP） ,endothelin-1 （ET-1）,yon Willebrand factor （vWF） levels in newborns with persistent pulmonary hypertension （PPHN） after the treatment of sitdenafil. Methods Sixty-six cases with PPHN group and 40 cases with non-PPHN （control group） were enrolled. PPHN group was in the treatment of sildenafil. Collected the blood when before the treatment of sildenalil and 3,7 d after treatment, respectively. Arterial blood gas were done and pulmonary arterial systolic pressure （PASP） was measured before treatment and 3,7 d after treatment, and by the same time recording pulse oxygen saturation （SpO2）. Plasma ANP, ET-I,vWF levels were measured by ELISA method. Results The levels of PASP,SpO2 arterial partial pressure of oxygen （PaO2）,arterial partial pressure of carbon dioxide （PaCO2） and plasma ANP,ET-1 ,vWF in PPHN group before treatment [（66.5 ± 13.4）mm Hg （1 mm Hg = 0.133 kPa）,0.726 ±0.531, （46.3 ±7.2）mm Hg, （59.2 ± 7.4） mm Hg, （272.6 ± 20.3 ）ng/L, （221.3 ± 24.3 ） ng/L, （ 142.5 ± 20.3）% ] compared with control group [（25.0 ± 6.2） mm Hg,0.896 ± 0.767, （88.3 ± 7.6） mm Hg, （41.1 ± 6.1 ）mm Hg, （68.4 ± 7.9） ng/L, （39.8 ± 6.5 ） ng/L, （95.3 ± 18.5 ）%] were statistically significant（P 〈 0.05 ）. Their levels in PPHN group 3 d after treatment [ （48.3 ± 3.2） mm Hg, 0.841 ± 0.416, （73.6 ± 9.3 ）mm Hg, （50.5± 7.2） mm Hg, （ 102.6 ± 20.3） ng/L, （79.6 ± 15.2） ng/L, （103.6 ± 14.1）% ] were significantly improved,there was significant difference compared with before treatment and control group （P 〈 0.05 ）. Their levels in PPHN group 7 d after treatment [ （25.2 ± 3.6） mm Hg,0.882 ± 0.724, （85.4 ± 7.4） mm Hg, （40.2 ±6.4） mm Hg, （64.4 ± 3.6） ng/L, （37.3 ±5.4）ng/L, （92.9 ± 11.7）% ] were significantly improved,there was significant difference compared with 3 d after treatment （P 〈 0.05）,the difference was no statistically significant compared with control group （P 〉 0.05 ）. Linear correlation analysis showed that ANP, ET-1, vWF and PASP, PaCO2 were significantly positively correlated （P 〈 0.01 ）, ANP, ET- 1, vWF and SpO2, PaO2 were significantly negatively correlated （P 〈 O.Ol ）. On the basis of cardiac ultrasound monitoring PASP, ANP evaluation of the efficacy of sildenafil sensitivity was 82.2%, specificity was 83.4% ;ET-1 was 86.4% and 87.6%; vWF was 85.1% and 84.7%. Conclusion ANP, ET-1, vWF may play an important role in the mechanism of the treatment of PPHN by sildenafil, and could be used as an objective index to evaluate the effect of sildenafil on PPHN.