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目的探讨先天性心脏病(CHD)合并肺动脉高压(PH)患儿手术前后硫化氢(H2S)及血红蛋白氧合酶-1(HO-1)的变化及其临床意义。方法选取河北医科大学第四医院心脏外科收治的48例左向右分流的CHD患儿,均在复合麻醉中成功实施了根治手术。48例患儿行心脏多普勒术前测压,按照肺动脉收缩压高低(PASP)分为3组:无PH组(PASP<3.990kPa)15例,轻度PH组(PASP3.990～6.517kPa)15例,中重度PH组(PASP≥6.650kPa)18例。于术前、术后1h及术后24h采集各组患儿桡动脉血标本,用吸光度法测定血浆H2S水平,用双波长分光光度法测定血清HO-1活性。数据分析采用重复测量数据的方差分析、多因素方差分析、直线相关分析。结果各组患儿术后H2S水平呈上升趋势,术后24h与术前比较差异均有统计学意义(Pa<0.05)。术前、术后1h及术后24h,中重度PH组、轻度PH组血浆H2S水平均显著低于无PH组(Pa<0.05),中重度PH组血浆H2S水平均显著低于轻度PH组(Pa<0.05);术前、术后1h、术后24h,3组患儿血清HO-1活性比较差异无统计学意义;3组患儿血清HO-1活性组间比较差异无统计学意义。术前、术后1h及术后24h,H2S水平与PASP均呈负相关(Pa<0.01)。术前、术后1h及术后24h,HO-1活性与PASP均无相关性(Pa>0.05)。结论H2S在PH形成和肺血管重建中发挥重要作用。HO-1与PASP无相关性,但不能排除HO-1在PH形成和肺血管重建中有重要作用。血浆HS可作为判断PH严重程度的指标之一。
Objective To investigate the changes and clinical significance of hydrogen sulfide (H2S) and hemoglobin oxygenase-1 (HO-1) in children with congenital heart disease (CHD) and pulmonary hypertension (PH) before and after operation. Methods Forty-eight CHD children with left-to-right shunt were enrolled in Department of Cardiology, the Fourth Hospital of Hebei Medical University. All of them underwent successful radical operation in combination anesthesia. 48 cases of children underwent cardiac Doppler preoperative pressure measurement, according to pulmonary artery systolic blood pressure (PASP) was divided into three groups: no PH group (PASP <3.990kPa) in 15 cases, mild PH group (PASP3.990 ~ 6.517kPa ) 15 cases, moderate and severe PH group (PASP≥6.650kPa) in 18 cases. Radial artery blood samples of each group were collected before operation, 1h after operation and 24h after operation. Plasma H2S level was measured by absorbance method and serum HO-1 activity was measured by dual wavelength spectrophotometry. Data analysis using repeated measures of variance analysis, multivariate analysis of variance, linear correlation analysis. Results The levels of H2S in children in each group showed an upward trend after operation, and the difference was statistically significant at 24 hours after operation (P <0.05). The levels of plasma H2S in the moderate and severe PH group and the mild PH group were significantly lower than those in the non-PH group (P <0.05), and the levels of H2S in the moderate and severe PH group were significantly lower than those in the mild PH group (P0.05). There was no significant difference in the serum HO-1 activity between preoperative, postoperative 1h, postoperative 24h and postoperative 3 groups. There was no significant difference in the serum HO-1 activity between the three groups significance. Preoperative, postoperative 1h and postoperative 24h, H2S levels were negatively correlated with PASP (Pa <0.01). There was no correlation between HO-1 activity and PASP before operation, 1h after operation and 24h after operation (Pa> 0.05). Conclusion H2S plays an important role in PH formation and pulmonary vascular remodeling. HO-1 and PASP no correlation, but we can not rule out HO-1 in PH formation and pulmonary vascular reconstruction has an important role. Plasma HS can be used as one of the indicators to judge the severity of PH.