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目的探讨常规剂量卡托普利口服预防室间隔缺损(VSD)继发肺动脉高压的效果和作用机制。方法将成都市妇女儿童中心医院2013年7月至2015年7月收治的符合纳入标准的40例VSD患儿随机均分成空白对照组和卡托普利干预组,于0、1、4、8、12周心脏超声测量肺动脉收缩压(PASP)、肺循环血流量/体循环血流量(Qp/Qs)、右室Tei指数,ELISA方法检测血浆基质金属蛋白酶9(MMP-9)、金属蛋白酶组织抑制因子1(TIMP-1)水平,并观察药物副反应。结果 PASP、Qp/Qs、右室Tei指数、血浆MMP-9、TIMP-1水平在空白组随时间逐渐升高,而干预组随时间逐渐降低,变化趋势组间差异有统计学意义(均P<0.05)。所有指标在0周时比较差异无统计学意义(均P>0.05);1、4、8、12周4个时间点干预组PASP、右室Tei指数低于空白组(均P<0.05);4、8、12周3个时间点干预组Qp/Qs、血浆MMP-9、TIMP-1水平低于空白组(均P<0.05)。干预组患儿无一例发生药物副反应。结论对择期手术VSD患儿口服常规剂量卡托普利可改善PASP、右室Tei指数、Qp/Qs指标,可能机制之一是通过降低血浆MMP-9、TIMP-1水平,减轻肺血管重构,预防肺动脉高压,以达到最佳手术年龄。
Objective To investigate the effect and mechanism of oral administration of captopril in the prevention of pulmonary hypertension secondary to ventricular septal defect (VSD). Methods Forty children with VSD who met the inclusion criteria from July 2013 to July 2015 in Chengdu Women and Children Hospital were randomly divided into blank control group and captopril intervention group. Pulmonary artery systolic pressure (PASP), pulmonary circulation blood flow / systemic blood flow (Qp / Qs) and Tei index of right ventricle were measured by echocardiography at 12 weeks. The levels of MMP-9, (TIMP-1) levels, and observed drug side effects. Results The levels of PASP, Qp / Qs, Tei index of right ventricle, plasma MMP-9 and TIMP-1 in the blank group increased gradually with time, while the intervention group decreased gradually with time, the trend of the trend was statistically significant (P <0.05). The indexes of PASP and Tei in right ventricle were lower than those in the blank group at 4, 8, and 8 weeks (all P> 0.05). There was no significant difference between the two groups at 0 week (all P> 0.05). Qp / Qs, plasma MMP-9 and TIMP-1 levels in the intervention group were lower than those in the blank group at 4, 8 and 12 weeks (all P <0.05). No case of drug intervention in children with side effects. Conclusions Oral administration of captopril in children with elective surgery can improve the PASP, Tei index and Qp / Qs of right ventricle. One of the possible mechanisms is to reduce the plasma levels of MMP-9 and TIMP-1 and reduce the remodeling of pulmonary vessels , Prevent pulmonary hypertension, in order to achieve the best surgical age.