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目的探讨先天性心脏病(CHD)患儿肺动脉高压(PH)形成的影响因素。方法研究对象均为2003-06—2005-02于北京大学深圳医院收集病例,以健康者30名为对照组(A组),以肺动脉压正常和并发PH的左向右分流的CHD患儿各30例为观察组(B组、C组)。以高效液相色谱法、硝酸还原法及放射免疫法测定其血清精氨酸(L-Arg)、一氧化氮(NO)、血浆内皮素(ET-1)的浓度。结果血清L-Arg浓度:对照组(A组)为(72·00±18·01)nmol/mL,肺动脉压正常的患儿(B组)为(30·74±8·97)nmol/mL,伴PH的患儿(C组)为(23·51±12·37)nmol/mL。血清NO浓度:A组为(76·10±17·10)nmol/mL,B组(90·55±26·57)nmol/mL,C组(60·05±17·60)nmol/mL。血浆ET-1浓度:A组(50·82±7·58)pg/mL,B组(64·90±16·28)pg/mL,C组(69·64±10·66)pg/mL。结论血清NO浓度和血浆ET-1浓度及其之间的平衡关系共同影响PH的形成及其程度。血浆ET-1浓度的升高是肺动脉压升高的直接因素,血清NO浓度的降低是间接因素,而血清NO浓度降低是由血清L-Arg浓度的降低引起。
Objective To investigate the influencing factors of pulmonary hypertension (PH) in children with congenital heart disease (CHD). Methods All subjects were from June 2003 to June 2005 in Shenzhen Hospital of Peking University. Thirty healthy subjects were enrolled as control group (A group), CHD children with normal pulmonary arterial pressure and left-right shunt with PH 30 cases for the observation group (B group, C group). Serum arginine (L-Arg), nitric oxide (NO), and plasma endothelin (ET-1) concentrations were determined by high performance liquid chromatography, nitrate reduction and radioimmunoassay. Results Serum L-Arg concentration was (72.00 ± 18.01) nmol / mL in the control group (group A) and (30.74 ± 8.77) nmol / mL in the normal pulmonary artery pressure group (group B) (23.51 ± 12.37 nmol / mL) in children with PH (group C). Serum NO concentration was 76.1 ± 17.10 nmol / mL in group A, 90.55 ± 26.57 nmol / mL in group B and 60.05 ± 17.60 nmol / mL in group C, respectively. Plasma concentrations of ET-1: pg / mL of group A (50.82 ± 7.88), group B (64.90 ± 16.28) pg / mL and group C (69.64 ± 10.66) pg / mL . Conclusion The serum NO concentration and plasma ET-1 concentration and the balance between them affect the formation of PH and its extent. Plasma ET-1 concentration is the direct cause of pulmonary hypertension, serum NO concentration is an indirect factor, and serum NO concentration decreased serum L-Arg concentration caused by the decrease.