肾上腺髓质素及尾加压素Ⅱ在先天性心脏病肺动脉高压中作用的研究

目的探讨先天性心脏病(CHD)合并肺动脉高压(PH)患者手术前后血浆肾上腺髓质素(ADM)及尾加压素Ⅱ(UⅡ)变化的临床意义。方法将52例患者按肺动脉收缩压分为3组:无PH组(<30 mm Hg)17例,轻度PH组(30~49 mm Hg)18例,中重度PH组(≥50 mm Hg)17例。测定3组术前、术后即刻及术后7 d ADM及UⅡ含量,并比较手术前后的变化;分析两者及其与肺动脉压(PAP)间的相互关系。结果(1)3组患者肺动脉压(PAP)与血浆ADM浓度呈正相关(术前r=0.8012,P<0.01;术后即刻r=0.6325,P<0.01;术后7 dr=0.7126,P<0.01)。(2)3组患者UⅡ浓度则与PAP无相关性(均P>0.05)。(3)无PH组术前ADM浓度为33 pg/m l±5 pg/m l、术后即刻为29 pg/m l±4 pg/m l、术后7 d为20 pg/m l±3 pg/m l;轻度PH组术前ADM浓度为44 pg/m l±8 pg/m l、术后即刻40 pg/m l±6 pg/m l、术后7 d为34 pg/m l±4 pg/m l;中重度PH组术前ADM浓度为60 pg/m l±10 pg/m l、术后即刻58 pg/m l±8 pg/m l、术后7 d为38 pg/m l±4 pg/m l。各组术后ADM浓度呈下降趋势,但只有术后7 d与术前比较差异有统计学意义(无PH组q=5.41,P<0.01;轻度PH组q=4.76,P<0.01;中重度PH组q=6.32,P<0.01)。(4)无PH组术前UⅡ浓度为2.2 pmol/L±0.5pmol/L、术后即刻为2.2 pmol/L±0.44 pmol/L、术后7 d为2.2 pmol/L±0.6 pmol/L;轻度PH组术前UⅡ浓度为2.7 pmol/L±0.6 pmol/L、术后即刻2.6 pmol/L±0.6 pmol/L、术后7 d为2.6 pmol/L±0.5pmol/L;中重度PH组术前UⅡ浓度为2.9 pmol/L±0.6 pmol/L、术后即刻2.6 pmol/L±0.7 pmol/L、术后7 d为2.8 pmol/L±0.4 pmol/L。3组患者手术前后UⅡ浓度差异无统计学意义(均P>0.05)。结论(1)ADM在PH形成和血管重建中发挥重要的作用。(2)UⅡ与PAP无相关性,但是不能排除UⅡ在PH形成和血管重建中有重要的作用。(3)血浆ADM水平可作为判断PH严重程度的指标之一。

Study on the effect of adrenomedulin and urotensin-II on pulmonary hypertension of patients with congenital heart disease

OBJECTIVE: To evaluate the effect and clinical significance of adrenomedulin (ADM) and urotensin-II (UII) on pulmonary hypertension (PH), by detecting their levels of patients with congenital heart disease and pulmonary hypertension. METHODS: 52 patients with congenital heart disease who had left-to-right shunt were selected randomly. 52 patients were divided three groups according to pulmonary artery systolic pressure (PASP): group A was not pulmonary hypertension (PASP < 30 mm Hg, n = 17); group B was mild pulmonary hypertension (PASP30-49 mm Hg, n = 18); group C was moderate and severe pulmonary hypertension (PASP > or = 50 mm Hg, n = 17). The plasma levels of ADM and UII were detected at each period by radioimmunoassay (RIA) method. It was analyzed the changes of their levels within pre-operation, 20 mins and 7 days post-operation and the interrelation between them and PASP. RESULTS: (1) Following the severity degree of pulmonary hypertension, the plasma levels of ADM increase. There is positive correlation between PAP and plasma level of ADM (pre-operation r = 0.8012, P < 0.01; 20 min post-operation r = 0.6325, P < 0.01; 7 d post-operation r = 0.7126, P < 0.01). (2) Following the severity degree of pulmonary hypertension, the plasma levels of UII don't change obviously. There is no correlation between PAP and plasma level of UII (P > 0.05). (3) The plasma levels of ADM: group A (pre-operation: 33 pg/ml +/- 5 pg/ml, 20 mins post-operation: 29 pg/ml +/- 4 pg/ml, 7 d post-operation: 20 pg/ml +/- 3 pg/ml); group B (pre-operation: 44 pg/ml +/- 8 pg/ml, 20 mins post-operation: 40 pg/ml +/- 6 pg/ml, 7 d post-operation: 34 pg/ml +/- 4 pg/ml); group C (pre-operation: 60 pg/ml +/- 10 pg/ml, 20 mins post-operation: 58 pg/ml +/- 8 pg/ml, 7d post-operation: 38 pg/ml +/- 4 pg/ml). Plasma level of ADM of each group after CPB is lower than that of each group before operation. It is statistical difference only 7 days post-operation (group A q = 5.41, P < 0.01; group B q = 4.76, P < 0.01; group C q = 6.32, P < 0.01). (4) The plasma levels of UII: group A (pre-operation: 2.2 pmol/L +/- 0.5 pmol/L, 20 mins post-operation: 2.2 pmol/L +/- 0.44 pmol/L, 7 d post-operation: 2.2 pmol/L +/- 0.6 pmol/L); group B (pre-operation: 2.7 pmol/L +/- 0.6 pmol/L, 20 mins post-operation: 2.6 pmol/L +/- 0.6 pmol/L, 7 d post-operation: 2.6 pmol/L +/- 0.5 pmol/L); group C (pre-operation: 2.9 pmol/L +/- 0.6 pmol/L, 20 mins post-operation: 2.6 pmol/L +/- 0.7 pmol/L, 7 d post-operation: 2.8 pmol/L +/- 0.4 pmol/L). Compared with that of each group before operation, Plasma level of UII of each group after operation is no obvious difference (P > 0.05). CONCLUSION: (1) Following the severity degree of pulmonary hypertension, the plasma levels of ADM increase. ADM plays an important role in the formation of pulmonary hypertension and restructure. (2) Following the severity degree of pulmonary hypertension, the plasma levels of UII don't change obviously. There is no correlation between PAP and plasma level of UII, but UII may be play an important role in the formation of pulmonary hypertension and restructure. (3) Measuring the levels of ADM may be a reliable method to follow the change of pulmonary pressure and worsening of pulmonary hypertension.