重症肺炎婴幼儿血浆肾上腺髓质素、内皮素-1水平的变化及其与心功能的关系

目的研究重症肺炎并急性充血性心力衰竭婴幼儿血浆肾上腺髓质素(ADM)、内皮素-1(ET-1)水平的变化,探讨其与心功能的关系。方法选择本院儿科住院肺炎患儿47例,其中支气管肺炎急性期并心力衰竭(无先天性心脏病)患儿15例(A1组);左向右分流先天性心脏病重症肺炎并急性充血性心力衰竭患儿12例(B1组);轻症肺炎患儿20例(C1组)。A2、B2、C2为A1、B1、C1组患儿恢复期。健康儿童20例(D组)。采用特异性放射免疫分析法测定肺炎患儿急性期(治疗前)、恢复期及健康对照儿童血浆ADM、ET-1水平。结果1.急性期血浆ADM水平:A1、B1、C1组均较D组明显升高(Pa<0.01);B1组高于A1、C1组(Pa<0.05),A1组高于C1组,差异有显著性(P<0.05)。2.急性期血浆ET-1水平:A1、B1组均分别高于C1、D组(Pa<0.05),B1组高于A1组,差异有显著性(P<0.05),C1组与D组比较差异不显著(P>0.05)。3.A2、B2组血浆ADM、ET-1均较其急性期明显下降(P<0.05,0.01);C2组血浆ADM较其急性期明显下降(P<0.01),而血浆ET-1急性期与恢复期均无明显改变(Pa>0.05)。结论ADM、ET-1参与重症肺炎并急性充性心力衰竭的病理生理过程。ET-1参与心力衰竭的发生发展,其血浆水平与心力衰竭程度有关。

Changes of Plasma Adrenomedullin,Endothelin-1 in Infants with Severe Pneumonia and Its Relationship with Heart Function

Objective To investigate the changes of plasma adrenomedullin(ADM),endothelin-1(ET-1) in infants with severe pneumonia complicated by acute congestive heart failure,and its relationship with heart function.Methods Forty-seven bronchopneumonia patients in their acute phase were divided into three groups:group A1,severe pneumonia complicated by acute congestive heart failure without congenitive heart disease(CHD)(n=15);group B1,severe pneumonia complicated by acute congestive heart failure with CHD(n=12);group C1,mild bronchopneumonia(n=20).A2,B2 and C2 groups were the convalescence groups of A1,B1 and groups C1 respertively.Group D,20 healthy infants were used as control group.Plasma ADM,ET-1 levels of patients in acute phase(pre-treatment)and convalescent phase and controls were measured by specific radioimmunoassary.Results 1.The plasma ADM levels significantly increased in the acute phase of A1,B1 and C1 compared with healthy controls(Pa<0.01).The plasma ADM levels were higher in group B1 than that in group A1 and C1,and were higher in group A1 than that in group C1(Pa<0.05).2.The plasma ET-1 levels apparently increased in group A1 and B1 compared with that in group D and C1(Pa<0.05).The plasma ET-1 levels were higher in group B1 than that in group A1(Pa<0.05),and that in group A1 was higher than that in group C1(Pa<0.05).No significant difference was found between group C1 and D(Pa>0.05).3.The plasma ADM,ET-1 levels in A2 and B2 groups significantly decreased compared with those in group A1 and B1(Pa<0.05,0.01).The plasma ADM levels in group C2 significantly decreased compared with that in group C1(Pa<0.01),while the plasma ET-1 levels between group C2 and C1 had no significant diffe-rence(Pa>0.05).Conclusions The ADM,ET-1 play very important roles in the pathophysiological processes of pneumonia and congestive heart failure in infants.ET-1 may play an important role in the pathogenesis of severe pneumonia in infants complicated with congestive heart fai-lure.The level of plasma ET-1 is related with the degree of congestive heart failure.