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目的:观察先天性心脏病(先心病)介入封堵术前后血浆血管紧张素Ⅱ(AngⅡ)的浓度变化,探讨其在先心病伴肺动脉高压(PH)中的作用及其临床意义。方法:选取70例儿童和70例成人先心病患者,儿童或成人患者中均分为中重度PH组[肺动脉收缩压>50mmHg(1mmHg=0.133kPa)]、轻度PH组(30mmHg≤肺动脉收缩压≤50mmHg)、无PH组(肺动脉收缩压<30mmHg)。用放射免疫法测定所有患者术前,术后24h、1、3、6及12个月血浆AngⅡ浓度。另选取年龄及性别与之相匹配的正常体检儿童30例,成人30例作为对照组。结果:介入封堵术前,无论儿童或成人先心病中重度PH、轻度PH组患者血浆AngⅡ水平均明显高于先心病无PH组患者(P<0.01)。先心病患者介入封堵术后24h,AngⅡ开始逐渐下降,至12个月下降到正常水平。结论:AngⅡ可能参与了先心病伴PH的发生、发展过程。
Objective: To observe the plasma concentration of angiotensin Ⅱ (Ang Ⅱ) in patients with congenital heart disease (CHD) before and after the interventional cardiopulmonary occlusion, and to explore its clinical significance in CHD with pulmonary hypertension (PH). Methods: Seventy children and 70 adults with CHD were enrolled in this study. All children were divided into moderate and severe PH group (pulmonary systolic pressure> 50mmHg (1mmHg = 0.133kPa)], mild PH group (30mmHg≤ pulmonary systolic pressure ≤ 50mmHg), no PH group (pulmonary systolic pressure <30mmHg). Plasma AngⅡ concentrations in all patients were measured by radioimmunoassay at preoperative, postoperative 24h, 1, 3, 6 and 12 months. In addition, 30 healthy children and 30 adults were selected as control group according to age and gender. Results: Before interventional occlusion, the level of plasma AngⅡ in children with moderate to severe PH or moderate PH was significantly higher than those without PH (P <0.01). In patients with congenital heart disease, the AngⅡ began to decline gradually after 24 hours of occlusion, and then decreased to normal level in 12 months. Conclusion: Ang Ⅱ may be involved in the pathogenesis and development of PH in congenital heart disease.