内皮素心钠素在左向右分流型先天性心脏病肺动脉高压的相关性研究

目的探讨血浆内皮素(ET)、心钠素(ANP)在左向右分流型先天性心脏病(CHD)肺动脉高压形成中的相互关系及临床意义。方法左向右分流型CHD合并肺动脉高压患者32例,正常对照组14例。采用放射性免疫法测定血浆ET、ANP的浓度,分析上述各指标在病变进展过程中的变化特点及相关性。结果①CHD各组术前肘静脉ET的浓度大于对照组(P<0.05);轻度肺动脉高压组与高肺血流量组之间术前肘静脉ET浓度差异无统计学意义(P>0.05);轻度、中度与重度肺动脉高压组之间的术前肘静脉ET浓度差异有统计学意义(P<0.05);重度>中度>轻度肺动脉高压组。②CHD各组术前肘静脉血浆ANP浓度分别明显高于正常对照组(P<0.05);高肺血流量组、轻度、中度与重度肺动脉高压组之间术前肘静脉血浆ANP浓度差异有统计学意义(P<0.05);重度>中度>轻度>高肺血流量组。③CHD各组肺动脉血浆ET浓度与肺动脉收缩压/主动脉收缩压呈正相关关系(r=0.794,P<0.01);ANP浓度与肺动脉收缩压/主动脉收缩压呈正相关关系(r=0.700,P<0.01)。④CHD各组术前肘静脉血浆ET与ANP浓度之间呈正相关关系(r=0.891,P<0.01)。结论ANP、ET共同参与了肺动脉高压的病理生理过程,ET合成增多,使缩血管物质与舒血管物质间失衡,促进了肺动脉高压的发生发展;ANP的升高则为机体的一种防御性反应,对维持肺循环稳定,减缓肺动脉高压的发生发展有积极作用。本实验将为延缓肺动脉高压形成或逆转失去手术机会的肺动脉高压患者的治疗提供一定的实验根据。

Correlation between endothelin and atrial natriuretic peptide in plasma of pulmonary hypertension with congenital heart disease

Objective To explore the clinical significance of plasma endothelin(ET) and atrial natriuretic peptide(ANP) in pulmonary hypertension(PH) associated with congenital heart disease(left-to-right shunt type),and the correlation between plasma ET and ANP.Methods Plasma ET and ANP levels were measured by radioimmunoassay at different stages in 32 patients with CHD and 14 normal subjects.The patients with CHD were divided into four groups(each,n=8) according to pulmonary artery systolic pressure/system artery systolic pressure(PASP/SAP): high pulmonary flow group mild-PH group,moderate-PH group and severe-PH group.Samples were obtained at admission and before cardiopulmonary bypass.Results ①Plasma ET from cubital vein in groups 1,2,3 and 4 before operation was significantly higher than in control group (P<0.05).The difference between groups 1 and 2 was not significant (P>0.05).The difference between groups 2,3 and 4 was significant: ET of groups 4>3>2 (P<0.05).②The plasma concentration of ANP from cubital vein before operation in groups 1,2,3 and 4 was significantly higher than that of control group: groups 4>3>2>1 (P<0.05). ③Plasma ET from pulmonary artery in cases of CHD positively correlated with PASP/SAP (r=0.794,P<0.01);Plasma ANP level from pulmonary artery in cases of CHD positively correlated with PASP/SAP (r=0.700,P<0.01).④Plasma ET level in cases of CHD positively correlated with ANP (r=0.891,P<0.01).Conclusion During the progression of PH in cases of CHD,plasma ET and ANP play an important role in the development of PH.ANP may be involved in protective mechanism against further increase of pulmonary arterial pressure.ET can be used as a reliable indicator of the severity of PH associated with CHD.ET and ANP correlate with PH severity,and their secretion imbalance leads to prolongation of the disease course.