婴儿重症肺炎并急性心力衰竭时血浆内皮素和降钙素基因相关肽及动脉血氧分压的相关研究

目的：探讨婴儿重症肺炎合并急性充血性心力衰竭（婴儿肺炎并心衰）时血浆内皮素（ET）水平变化的影响因素。方法：用放射免疫分析法，同期动态观测了26例肺炎并心衰患儿血浆ET、降钙素基因相关肽（CGRP）及动脉血氧分压（PaO2)变化。结果：心衰急性期（治疗前）血浆ET含量较其自身缓解期（治疗后）、轻型肺炎组及正常对照组均显著增高（P均＜0．01），而同期测定的血浆CGRP含量及PaO2值则较其自身缓解期及正常对照组均显著降低（P均＜0．01）；心衰缓解期与型肺炎组与轻型肺炎组和正常对照组间血浆ET、CGRP水平及PaO2值变化无统计学差异（P均＞0．05）。心衰急性期血浆ET含量变化与血浆CGRP水平呈显著负相关（P＜0．01），与PaO2值亦至显著负相关（P＜0．01）。结论：血浆ET水平增高是促进婴儿重症肺炎合并心衰发生发展的重要因素；血浆ET水平增高的原因可能与血浆CGRP含量降低及PaO2下降有关；动态监测血浆ET及CGRP含量变化对判断病情及预后有重要临床意义。

The correlations among plasma endothelin levels and calcitonin gene-r elated pept ide as well as partial pressure of arterial oxygen in infants with severe pneumo nia complicated by acute congestive heart failure

Objective:To investigate the clinical significance of changes in plasma endothelin (ET) levels in infants with severe pneumonia complicated by acute congestive heart failure.Methods:Plasma ET and calcitonin generelated peptide (CGRP) levels (radioimmunoassay) and partial pressure of arterial oxygen (PaO 2) were measured in 26 patients.Results:The results showed that the plasma ET levels significantly increased but plasma CGRP levels and PaO 2 significantly decreased in the critical stage group of heart failure compared with its convalescence group ( n= 26),mild bronchopneumonia group ( n= 20) and normal controls ( n= 16,all P <0 01).No significant differences in plasma ET,CGRP levels and PaO 2 were observed among those groups in convalescence,mild bronchopneumonia,and normal controls(all P >0 05).There was a significant negative correlation between plasma ET and CGRP levels ( P <0 01) in the critical stage of heart failure,and also between plasma ET and PaO 2 ( P <0 01).Conclusions:The findings suggest that the increase in plasma ET level may play an important role in the pathogenesis of the severe pneumonia complicated by acute congestive heart failure in infants.The elevation of plasma ET level seems to be related to the decrease of plasma CGRP level and the decrease of PaO 2.