儿童先天性心脏病介入治疗前、后心肌损伤的研究

目的通过动态监测血清心肌型脂肪酸结合蛋白(H-FABP)和心肌肌钙蛋白I(cTnI),观察使用国产封堵器介入治疗先天性心脏病时心肌损伤的情况。方法随机选取动脉导管未闭(PDA)24例、房间隔缺损(ASD)20例、室间隔缺损(VSD)16例,动态监测cTnI、H-FABP的变化。结果 60例先天性心脏病患儿血清H-FABP、cTnI术前浓度平均分别为1.28±0.57μg/L、0.02±0.01μg/L;术后(10±5)min分别为8.51±5.47μg/L、0.46±0.49μg/L,术后4 h分别为2.31±1.73μg/L、0.66±0.45μg/L,24 h明显下降,各时间点差异有统计学意义(P<0.01)。结论先天性心脏病介入治疗存在心肌损伤,并与先天性心脏病类型有一定关系。H-FABP较cTnI更早出现峰值浓度,是早期判断心肌损伤的理想指标,测量cTnI、H-FABP可为临床防治术后并发症提供科学依据。

The research of myocardial damage in children with congenital heart diseases before and after paediatric cardiovascular intervention

Objective To investigate the myocardial damage in congenital heart diseases after paediatric cardiovascular intervention by the made-in-China occluder through monitoring the changes of heart fatty acid-binding protein（H-FABP） and cardiac troponin I（cTnI） dynamically.Methods A total of 24 patent ductus arteriosus（PDA） patients,20 atrial septal defect（ASD） patients and 16 ventricular septal defect（VSD） patients were enrolled,and their serum levels of cTnI and H-FABP were monitored dynamically.Results The results of serum H-FABP and cTnI concentrations were 1.28±0.57 μg/L and 0.02±0.01 μg /L at preoperative time,respectively.After the operation,they were 8.51±5.47 μg/L and 0.46±0.49 μg/L after（10±5） min,and 2.31±1.73 μg/L and 0.66±0.45 μg/L after 4 h,respectively,and then they were decreased obviously after 24 h with statistical significance（P0.01）.Conclusions After paediatric cardiovascular intervention,it exists myocardial damage which is related to the kinds of congenital heart diseases.Compared with cTnI,the serum H-FABP is an early and sensitive marker for predicting myocardial damage.It is useful to prevent postoperative complications by monitoring H-FABP and cTnI.