先天性心脏病合并心功能不全患者心肌AMP分解途径的探讨

目的: 观察先心病合并慢性心功能不全患者心肌中一磷酸腺苷(AMP)代谢途径的变化。方法: 随机选取手术治疗的先心病患者27例,年龄(11.9±13.6)岁,男性15例,女性12例。按纽约心功能分级(NYHA)分3组,A组为心功能正常组(Ⅰ级),B组为心功能轻度受损组(Ⅱ级),C组为心功能重度受损组(Ⅲ-Ⅳ级)。手术中体外循环前剪取右心耳心肌,以高效液相色谱法测定心肌中AMP及其代谢产物腺苷(Ado)和次黄嘌呤核苷酸(IMP)的含量。同时观察左心室EF值与AMP及其代谢产物Ado和IMP含量、Ado和IMP比值变化,观察心内矫治手术后心衰等并发症。结果: 3组心肌AMP含量无显著差异,C组心肌Ado含量明显低于B组,IMP含量高于B组。B组和C组IMP与Ado含量的比值(K常数)增高。术前左心室EF值与K常数呈负相关。K常数值明显增高者,心内矫治术后发生心衰较多。结论: 随着先心病患者心功能的降低,心肌AMP分解偏向于生成次黄嘌呤核苷酸。术前左心室EF降低与AMP分解代谢异常有关,应注意术后心衰的发生。

Catastatic pathways of adenosine monophosphate in failing cardiac myocytes of patients with congenital heart disease

AIM:To study the metabolic pathways of adenosine monophosphate (AMP) in the chronic failing cardiac myocytes of patients with congenital heart disease (CHD). METHODS:RESULTS:There was no significant statistic difference among the contents of AMP in three groups (P≥0. 05). The concentration of Ado was lower in the group C (P≤0. 05) and the concentration of IMP was higher significantly (P≤0. 05). There was a significant increase in the ratio of IMP/Ado in the three groups. Negative relationship was found between pre-operative EF of left ventricle and IMP/Ado (K constant). The higher K constant was, the higher incidence of post-operative heart failure would be. CONCLUSION: The metabolic pathway of AMP in the failing cardiac myocytes of CHD may go along with the way to create more IMP. The lower of pre-operative ejection fraction of left ventricle indicates the abnormal change of AMP catabolism, post-operation heart failure may be an important complication in these patients.