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目的探讨左向右分流型先天性心脏病合并肺动脉高压患儿血浆内皮素-1(ET-1)、降钙素基因相关肽(CGRP)及血栓素A2(TXA2)的变化及其受体在肺组织中的变化。方法采集60例左向右分流型先天性心脏病患儿血浆,采用酶免、放射性免疫及ELISA等方法测定ET-1、CGRP和TXB2含量,修补术中取患儿肺组织,采用RT-PCT的方法检测相应受体在肺组织中的表达变化。结果与对照组相比,观察组(先天性心脏病组)患儿血浆ET-1及TXB2的水平明显增高(P<0.05),而血浆CGRP的含量水平则明显降低(P<0.01);与无肺动脉高压组患儿相比中、重度肺动脉高压患儿血浆ET-1和TXB2的含量显著增高,而CGRP的含量则显著降低(P<0.05,P<0.01);经过PGE1治疗14 d后,患儿血浆ET-1和TXB2的含量显著降低(P<0.01),而CGRP的含量则无明显变化(P>0.05)。与无肺动脉高压组患儿相比合并肺动脉高压患儿肺组织中ET-1和TXA2受体的mRNA表达显著增高,而CGRP受体的mRNA表达量则显著降低(P<0.05,P<0.01)。结论ET-1、CGRP和TXA2与左向右分流型先天性心脏病合并肺动脉高压的发生与发展有着密切的联系,且测定这些指标可以用来判断其预后。
Objective To investigate the changes of plasma endothelin-1 (ET-1), calcitonin gene related peptide (CGRP) and thromboxane A2 (TXA2) in children with left-right shunt congenital heart disease complicated with pulmonary hypertension Changes in lung tissue. Methods Sixty children with congenital heart disease with left-to-right shunt were enrolled in this study. The levels of ET-1, CGRP and TXB2 were determined by enzyme-linked immunosorbent assay (ELISA), radioimmunoassay and ELISA. Of the method to detect the corresponding receptors in lung tissue expression changes. Results Compared with the control group, plasma levels of ET-1 and TXB2 in the observation group (congenital heart disease group) were significantly increased (P <0.05), while plasma CGRP levels were significantly decreased (P <0.01); and The levels of plasma ET-1 and TXB2 and the levels of CGRP in children without pulmonary hypertension were significantly lower than those in children with moderate and severe pulmonary hypertension (P <0.05, P <0.01). After PGE1 treatment for 14 days, The levels of plasma ET-1 and TXB2 in children were significantly decreased (P <0.01), while the contents of CGRP did not change significantly (P> 0.05). Compared with children without pulmonary hypertension group, the expression of ET-1 and TXA2 mRNA in lung tissue of children with pulmonary hypertension was significantly increased, while the mRNA expression of CGRP receptor was significantly decreased (P <0.05, P <0.01) . Conclusion ET-1, CGRP and TXA2 are closely associated with the occurrence and development of pulmonary hypertension in left-to-right shunt congenital heart disease. And these indexes can be used to judge the prognosis.