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目的探讨经导管封堵术对先心病(congenital heart disease,CHD)伴肺动脉高压(pulmon aryarterial hyperten-sion,PAH)患者血浆脑钠素(brain natriuretice peptide,BNP)浓度的影响及依那普利和美托洛尔的干预作用。方法选择肺动脉收缩压(SPAP)≥50mmHg的CHD患者119例,分为3组:A组(依那普利组,0.3～0.4mg.kg-1.d-1,n=44),B组(美托洛尔组,0.8～1.0mg.kg-1.d-1,n=39),C组(无药物干预,n=36)。分别于封堵术前当天及术后第4天、2个月、6个月抽血检测BNP浓度。药物干预组患者自术后第4天抽血后开始服药。另选同期在我院进行健康检者20例为对照组。结果①封堵术前,A、B、C3组血BNP水平比较无明显差异。与对照组比较,3组术前、术后第4天及C组术后2个月血BNP浓度均显著升高(P<0.01)。②用药前,A、B、C3组血BNP水平无明显差异(P>0.05)。术后2个月及6个月时,3组患者血BNP浓度均较用药前显著降低(P<0.01);A、B两组以及C组血BNP浓度分别于术后2个月及6个月恢复至对照组水平。③组间比较显示:A、B两组血BNP浓度于术后2个月时较C组显著降低(P<0.05),药物干预后A、B两组间血BNP浓度比较无显著性差异(P>0.05)。结论在介入治疗术后,CHD伴PAH患者的血BNP浓度先升高后降低,依那普利及美托洛尔均有促进其恢复的作用。
Objective To investigate the effect of transcatheter closure on the concentration of brain natriuretic peptide (BNP) in patients with congenital heart disease (CHD) and pulmonary hypertension (pulm aryarterial hypertention, PAH) and enalapril Tollor’s intervention. Methods One hundred and ninety-nine CHD patients with pulmonary arterial systolic pressure (SPAP) ≥50mmHg were divided into three groups: group A (enalapril, 0.3-0.4 mg.kg-1.d-1, n = 44), group B (Metoprolol group, 0.8 ~ 1.0mg.kg-1.d-1, n = 39), group C (no drug intervention, n = 36). BNP concentrations were measured on the day prior to occlusion and on the 4th, 2th, and 6th postoperative day respectively. Patients in the drug-intervention group started taking blood on the fourth day after surgery. Another election in the same period in our hospital 20 cases of health examination for the control group. Results ① There was no significant difference in blood BNP levels between groups A, B and C3 before closure. Compared with the control group, blood BNP levels were significantly increased (P <0.01) in 3 groups before operation, 4 days after operation and 2 months after operation in C group. ② Before treatment, there was no significant difference in serum BNP level between A, B and C3 groups (P> 0.05). At 2 months and 6 months after operation, the blood BNP levels of three groups were significantly lower than those before treatment (P <0.01). The levels of BNP in groups A and B and group C at 2 months and 6 months Month recovery to the control group level. ③Comparison between groups showed that serum BNP levels in group A and group B were significantly lower than those in group C at 2 months after operation (P <0.05). There was no significant difference in plasma BNP concentration between groups A and B after drug intervention P> 0.05). Conclusions After interventional therapy, BNP levels in CHD patients with PAH first increase and then decrease, and both enalapril and metoprolol can promote their recovery.