先天性心脏病患者血NT-proBNP浓度与肺动脉高压和导管封堵术的相关性

目的：研究先天性心脏病（CHD）患者血清氨基末端脑钠肽前体（NT-proBNP）浓度与肺动脉平均压（mPAP）的相关性.方法：62例行导管封堵治疗的CHD患者根据mPAP水平被分为四组：CHD不合并肺动脉高压（PAH）组（26例）、CHD合并轻度PAH组（17例）、CHD合并中度PAH组（12例）、CHD合并重度PAH组（7例）,同期选择20例健康体检者作为健康对照组.比较各组介入封堵术前后24h及3个月时的血清NT-proBNP浓度的变化并分析介入封堵术前NT-proBNP浓度与mPAP的关系.结果：与健康对照组相比,术前各CHD组血清NT-proBNP水平明显升高,且随着mPAP升高而显著升高健康对照组（34.0±16.8）pg/ml比CHD无PAH组（68.0±20.2）pg/ml比轻度PAH组（116.7±43.5） pg/ml比中度PAH组（273.1±64.2）pg/ml比重度PAH组（326.5±50.2） pg/ml,P均＜0.01];直线相关分析显示：62例CHD患者术前血清NT-proBNP浓度与mPAP呈正相关（r=0.604,P=0.002）.各组术后24hNT-proBNP浓度较术前升高,但只有CHD不合并PAH组有统计学差异（98.9±22.1） pg/ml比（68.0±20.2） pg/ml,P＜0.05],4组术后3个月NT-proBNP浓度较术前均有显著降低（P均＜0.01）.结论：先天性心脏病患者血清NT-proBNP浓度随肺动脉压力升高而逐渐升高,可作为先心病患者肺动脉高压程度以及预后判断的一个指标.

Correlation between serum NT-proBNP concentration and pulmonary artery hypertension and change of NT-proBNP concentration after transcatheter closure in patients with congenital heart disease

Objective： To study the correlation between serum N terminal pro brain natriuretic peptide （NT-proBNP） concen- tration and mean pulmonary arterial pressure （mPAP） in patients with congenital heart disease （CHD）. Methods.. Accord- ing to mPAP level, a total of 62 CHD patients undergoing transcatheter closure were divided into non- pulmonary artery hy- pertension （PAH） CHD group （ n = 26 ）, CHD ± mild PAIl group （ n = 17 ）, CHD ± moderate PAIl group （ n = 12 ） and CHD±severe PAH group （n=7）. Another 20 healthy subjects in the same period were selected as healthy control group. The changes of serum NT-proBNP concentration was compared among all groups before, 24h and three months after opera- tion. Correlation between NT-proBNP concentration and mPAP was analyzed before transcatheter closure. Results.. Com- pared with healthy control group, there was significant rise in serum NT-proBNP level in all CHD groups before operation, and it significantly elevated along with mPAP increased healthy control group （34.0 ±16. 8） pg/ml vs. CHD non-PAH group （68.0~20. 2） pg/ml vs. mild PAH group （116.7±43.5） pg/ml vs. moderate PAH group （273.1±64.2） pg/ml vs. severe PAH group （326.5 ± 50. 2） pg/mh P〈0.01 all]; linear correlation analysis indicated that serum NT-proBNP con- centration before operation was positively correlated with mPAP in 62 CHD patients （r = 0. 604, P= 0. 002）. On 24h after transcatheter closure, NT-proBNP concentration was significantly higher than before operation in all groups, but it pos- sessed significant difference only in non-PAH CHD group （98. 9±22.1） pg/ml vs. （68. 0±20.2） pg/ml, P〈0.05]. NT- proBNP concentration was significantly lower than before operation in all CHD groups after three months （P〈0.01 all）. Conclusion.. Serum NT-proBNP level rises along with pulmonary arterial pressure increased in patients with congenital heart disease, which could be used as an index judging severity of pulmonary artery hypertensi