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目的:研究经皮动脉导管未闭(PDA)介入封堵术对血浆心房钠尿肽(ANP)、脑钠尿肽(BNP)、心室重构的影响。方法:PDA经导管封堵术的患者16例,年龄相当的健康人16名为对照组,采用放射免疫与酶联免疫法分别检测二组术前及术后10min,2d,3月血浆ANP和BNP的水平。应用超声心动图测定左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)和主动脉瓣血流速度峰值(Vp)等,并将PDA封堵术前后血浆ANP和BNP的变化与LVEDD和LVESD等指标的变化作相关性分析。结果:PDA患者术前血浆ANP和BNP水平较正常组显著升高(P<0.01),术后10min,2d患者血浆ANP和BNP水平较术前显著升高(P<0.01),术后3月血浆ANP和BNP水平均恢复到正常范围。PDA封堵前左房内径,LVEDD,LVESD,LVFS,LVEF,Vp均较正常对照组明显增大(P<0.05),术后2d均明显减小(P<0.05),术后3月恢复到正常范围内,PDA封堵后右室舒张末期前后径(RVEDD)未见明显改变。PDA封堵术后血浆ANP和BNP水平的变化与LVEDD和LVEF的变化呈负相关。结论:介入封堵治疗后PDA患者血浆ANP和BNP水平短期内均显著升高,术后3月恢复正常。短期内血浆ANP和BNP水平的变化与LVEDD和LVEF的变化呈负相关。
Objective: To study the effects of percutaneous transcatheter arterial patenting (PDA) on plasma atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and ventricular remodeling. Methods: Sixteen patients with PDA via catheterization and 16 healthy controls were included in this study. Radioimmunoassay and enzyme-linked immunosorbent assay were used to detect plasma ANP, BNP level. The left ventricular end-diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) and peak aortic valve velocity were measured by echocardiography Vp). The changes of plasma ANP and BNP before and after PDA occlusion were analyzed with the changes of LVEDD, LVESD and other indexes. Results: The plasma levels of ANP and BNP in PDA patients were significantly higher than those in normal controls (P <0.01). The levels of ANP and BNP in patients with PDA at 2 and 3 days after operation were significantly higher than those before operation (P <0.01) Plasma ANP and BNP levels were restored to normal range. The diameter of left atrium, LVEDD, LVESD, LVFS, LVEF and Vp before PDA occlusion were significantly higher than those in normal control group (P <0.05), and were significantly decreased on the 2nd postoperative day (P <0.05) Within the normal range, there was no significant change in right ventricular diastolic anteroposterior diameter (RVEDD) after PDA occlusion. Changes in plasma ANP and BNP levels after PDA occlusion were negatively correlated with changes in LVEDD and LVEF. Conclusion: The levels of plasma ANP and BNP in PDA patients after interventional closure therapy were significantly increased in short term and returned to normal after 3 months. Short-term changes in plasma levels of ANP and BNP were negatively correlated with changes in LVEDD and LVEF.