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目的 :研究先天性心脏病 (CHD)患儿血浆内皮素 - 1(ET 1)浓度的变化 ,分析各种因素对ET 1浓度的影响 ,探讨CHD患儿血浆ET 1水平变化的机制和意义。方法 :对照组 :30例。观察组 :97例CHD患儿 ,其中肺充血组 69例 ,肺缺血组 2 8例 ;肺充血伴肺动脉高压 (肺高压 ,PH) 50例 ,不伴PH19例。用放免法直接测定每例静脉血中ET 1含量。结果 :①左向右分流的CHD患儿血浆ET 1浓度明显增加 ,达正常对照约 2 5倍 ,在PH形成之前ET 1浓度已经升高 ,达正常对照约 1 5倍 ;②PH病人ET 1含量增高且随肺动脉压的升高而增高 ;③心脏扩大对血浆ET 1浓度无影响 ;④前列腺素E1( 2 0～ 4 0ng·kg- 1·min- 1)可降低肺高压患儿血浆ET 1水平。结论 :肺血流量增加是ET 1生成增多的主要原因 ;ET 1可引起肺高压 ,肺高压可促进ET 1的产生 ,PGE1可延缓PH的形成和发展。
Objective: To study the changes of plasma endothelin - 1 (ET 1) levels in children with congenital heart disease (CHD) and analyze the influence of various factors on ET 1 concentrations and to explore the mechanism and significance of the changes of ET 1 levels in children with CHD. Methods: Control group: 30 cases. Observation group: 97 cases of CHD children, including pulmonary congestion in 69 cases, 28 cases of pulmonary ischemia; pulmonary congestion with pulmonary hypertension (PH) in 50 cases, without PH19 cases. Routine determination by radioimmunoassay each venous blood ET 1 levels. Results ① ① The ET 1 concentration in CHD children with left-to-right shunt significantly increased to about 25 times of the normal control, and the ET 1 concentration increased to about 15 times before PH formation. ② The ET 1 content in PH patients Increased with increasing pulmonary artery pressure; ③ heart enlargement had no effect on plasma ET 1 concentration; ④ prostaglandin E1 (20 ~ 40 ng · kg -1 · min -1) decreased plasma ET 1 Level. CONCLUSION: The increase of pulmonary blood flow is the main reason for the increase of ET 1 production. ET 1 can cause pulmonary hypertension and pulmonary hypertension can promote ET 1 production. PGE1 can delay the formation and development of PH.