新生儿持续肺动脉高压患儿血浆心房利钠肽、内皮素-1及血管性假血友病因子的变化

目的 探讨血浆心房利钠肽(ANP)、内皮素-1(ET-1)、血管性假血友病因子(vWF)水平在新生儿持续肺动脉高压(PPHN)中的变化及意义。方法 PPHN组患儿66例(轻度26例,中度21例,重度19例),对照组为非PPHN同期住院新生儿40例。对照组患儿入院时即行心脏超声检查,PPHN组患儿均于临床出现不易纠正的低氧血症(治疗前)及治疗后7 d行心脏超声检查测定肺动脉平均压(PASP),ELISA方法测定血浆ANP、ET-1、vWF的水平。结果 治疗前PPHN组患儿血浆ANP、ET-1、vWF水平较对照组明显升高(P<0.05),并随PASP增加而递增。治疗7 d后轻度及中度PPHN组患儿肺动脉压力恢复正常,血浆ANP、ET-1、vWF水平与对照组比较差异无统计学意义;重度组各指标较治疗前明显下降但仍高于对照组。治疗前后三指标水平均与PASP呈明显正相关(P<0.01)。结论 ANP、ET-1、vWF在PPHN治疗前后呈动态变化,且可反映肺动脉压力程度,动态监测有助于判断病情指导治疗。

Changes in plasma levels of atrial natriuretic peptide, endothelin-1 and von Willebrand factor among newborns with persistent pulmonary hypertension

Objective To investigate the changes in plasma levels of atrial natriuretic peptide (ANP), endothelin-1 (ET-1) and von Willebrand factor (vWF), and their significance among newborns with persistent pulmonary hypertension (PPH). Methods Sixty-six newborns with PPH (case group) (mild: 26 cases; moderate: 21 cases; severe: 19 cases), as well as 40 newborns without PPH (control group) who were hospitalized in the same period, were enrolled. The control group underwent echocardiography on admission. The case group underwent echocardiography before treatment (with refractory hypoxemia) and after 7 days of treatment for measurement of pulmonary artery systolic pressure (PASP). Meanwhile, plasma levels of ANP, ET-1 and vWF were measured using ELISA. Results Before treatment, the case group had significantly higher plasma levels of ANP, ET-1 and vWF than the control group (P<0.05), and these indices increased as PASP rose. After 7 days of treatment, the children with mild or moderate PPH showed normal PASP, and their plasma levels of ANP, ET-1 and vWF were not significantly different from those of control group. The children with severe PPH had significant decreases in all indices, but they were significantly higher than those of the control group. Plasma levels of ANP, ET-1 and vWF were significantly positively correlated with PASP before and after treatment (P<0.01). Conclusions Changes in plasma levels of ANP, ET-1 and vWF can reflect PASP in newborns with PPH during treatment. Dynamic monitoring of these indices can help to judge the severity of PPH and guide treatment.