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目的通过检测左向右分流型先天性心脏病(CHD)并肺动脉高压(PH)患儿血浆尾加压素Ⅱ(UⅡ)与血管内皮生长因子(VEGF)的水平,探讨其在左向右分流型CHD并PH中的临床意义。方法选择2008年1月-2009年1月本院心儿科收治的63例左向右分流型CHD患儿(男30例,女33例),均在右心导管检查中直接测定其肺动脉压力,按肺动脉平均压(mPAP)水平分为无PH组(mPAP≤25mmHg,1mmHg=0.133kPa)21例、轻中度PH组(25mmHg45mmHg)22例。取患儿肺动脉血,采用酶联免疫吸附法(ELISA)测定其肺动脉血浆UⅡ及VEGF水平,分析二者与mPAP的关系。结果 1.无PH组、轻中度PH组及重度PH组肺动脉血浆UⅡ水平比较差异无统计学意义(P>0.05)。肺动脉血浆UⅡ水平与mPAP无相关性(r=-0.003,P>0.05)。2.轻中度及重度PH组与无PH组肺动脉血浆VEGF水平比较差异均有统计学意义(Pa<0.01),轻中度PH组与重度PH组肺动脉血浆VEGF水平比较差异亦有统计学意义(P<0.05);肺动脉血浆VEGF水平与mPAP呈正相关(r=0.761,P<0.01)。结论 1.血浆UⅡ水平随PH程度的加重无明显变化,但不能排除UⅡ在PH形成和血管重建中起重要作用。2.VEGF参与了左向右分流型CHD并PH的病理生理过程,其血浆水平可作为评估左向右分流型CHD患儿PH严重程度的参考指标之一。
Objective To detect the levels of urotensin Ⅱ (UⅡ) and vascular endothelial growth factor (VEGF) in children with left-sided and right-sided shunt congenital heart disease (CHD) and pulmonary hypertension (PH) Type CHD and PH clinical significance. Methods From January 2008 to January 2009, 63 cases of left-to-right shunt CHD children (30 males and 33 females) admitted to our hospital from January 2008 to January 2009 were enrolled in this study. Their pulmonary artery pressure, According to the level of pulmonary arterial pressure (mPAP), 21 patients were divided into PH group (mPAP≤25mmHg, 1mmHg = 0.133kPa), mild and moderate PH group (25mmHg 45mmHg) example. Pulmonary arterial blood was taken from children. Pulmonary artery plasma UⅡand VEGF levels were measured by enzyme-linked immunosorbent assay (ELISA), and their relationship with mPAP was analyzed. Results 1. There was no significant difference in UⅡlevel of pulmonary artery between PH group, mild PH group and severe PH group (P> 0.05). UⅡ level in pulmonary artery plasma had no correlation with mPAP (r = -0.003, P> 0.05). The levels of VEGF in pulmonary arterial plasma in mild to moderate and severe PH group were significantly different from those in non-PH group (P <0.01), and there was significant difference in the level of VEGF in pulmonary arterial plasma between mild to moderate PH group and severe PH group (P <0.05). The level of VEGF in pulmonary arteries was positively correlated with mPAP (r = 0.761, P <0.01). Conclusions 1. There is no obvious change of plasma UⅡ level with the increase of PH, but it can not be ruled out that UⅡ plays an important role in the formation of PH and revascularization. 2.VEGF is involved in the pathophysiological process of left-to-right shunt CHD and PH, and its plasma level can be used as a reference index to evaluate the PH severity of children with left-to-right shunt CHD.