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目的探讨血浆肾上腺髓质素(ADM)的变化对先天性心脏病病理生理的影响。方法2005年1月至2007年11月筛选在山东大学第二医院儿内科住院的59例先心病患儿,在心导管检查术中测定血流动力学指数及采血备测,依据血流动力学特征分为高肺血流非肺动脉高压组、高肺血流并肺动脉高压组、紫绀组,平均肺动脉压(mPAP)>20mmHg(1mmHg=0.133kPa)为肺动脉高压的标准。选6名正常健康儿童作为对照组。采用特异性放射免疫法检测血浆ADM的水平。结果先心病患儿股静脉中的血浆ADM水平较股动脉明显增高(P<0.05);与对照组相比,高肺血流并肺动脑高压组及紫绀组中的ADM明显增高,均P<0.01;股静脉血浆ADM与主动脉平均压,主动脉血氧饱和度及混合静脉血氧饱和度均呈显著负相关;而与肺血管阻力有显著正相关。结论ADM的变化同肺动脉阻力和缺氧有密切关系,推测ADM水平的升高可能有助于减轻肺动脉阻力和改善缺氧。
Objective To investigate the effect of plasma adrenomedullin (ADM) on the pathophysiology of congenital heart disease. Methods From January 2005 to November 2007, 59 patients with CHD who were hospitalized in Department of Pediatrics, the Second Hospital of Shandong University were enrolled in this study. The hemodynamic indices and blood sampling were determined during cardiac catheterization. According to hemodynamic characteristics Divided into high pulmonary blood flow non-pulmonary hypertension group, high pulmonary blood flow and pulmonary hypertension group, cyanotic group, mean pulmonary arterial pressure (mPAP)> 20mmHg (1mmHg = 0.133kPa) is the standard of pulmonary hypertension. Six normal healthy children were selected as the control group. Specific radioimmunoassay was used to detect plasma ADM levels. Results Compared with the control group, the plasma ADM level in the femoral vein of CHD patients was significantly higher than that of the femoral artery (P <0.05). Compared with the control group, the ADM levels in the pulmonary hypertension group and the cyanotic group were significantly increased (P < 0.01; femoral venous plasma ADM with aortic mean pressure, aortic oxygen saturation and mixed venous oxygen saturation were significantly negatively correlated; and pulmonary vascular resistance was significantly positively correlated. Conclusions The change of ADM is closely related to pulmonary artery resistance and hypoxia. It is speculated that the increase of ADM may be helpful to reduce pulmonary artery resistance and improve hypoxia.