先天性心脏病合并不同程度肺动脉高压患儿手术前后血浆脑钠肽前体的变化

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摘要目的评价患儿血浆脑钠肽前体（NT-proBNP）在先天性心脏病合并不同程度肺动脉高压（PAH）手术前后不同时间的改变。方法收集2015年1月—2018年1月就诊于内蒙古医科大学附属医院诊治的先天性心脏病患儿60例。根据肺动脉压力分为四组，其中无PAH组16例，轻度PAH组16例，中度PAH组14例，重度PAH组14例。术前采用经胸超声心动图估测肺动脉收缩压，比较合并不同程度PAH组患儿手术前后不同时间血浆NT-proBNP浓度的变化。结果四组术前、术后NT-proBNP水平整体比较，差异有统计学意义（P ＜ 0.05）。其中无PAH组与轻度PAH组患儿血浆NT-proBNP水平比较，差异无统计学意义（P ＞ 0.05）；重度、中度PAH组血浆NT-proBNP水平高于无PAH组与轻度PAH组比较，差异有统计学意义（P ＜ 0.05）；重度PAH组血浆NT-proBNP水平低于中度PAH组患儿，差异有统计学意义（P ＜ 0.05）。术后轻度PAH组NT-proBNP水平高于术前，差异有统计学意义（P ＜ 0.05）。结论在临床中通过研究左向右分流先天性心脏病患儿手术前后血浆NT-proBNP水平随PAH严重程度的增高而逐渐升高，可作为评价PAH程度的一项指标，有助于保障患者的健康，值得在实际中应用。

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	郭俊晓任杰▲ 张玉龙刘志平

关键词 ：脑钠肽前体, 先天性心脏病, 肺动脉高压, 临床意义

Abstract：Objective To evaluate the changes of pro-brain natriuretic peptide (NT-proBNP) in children with congenital heart disease combined with different degrees of pulmonary hypertension (PAH) at different times before and after surgery. Methods A total of 60 children with congenital heart disease who were diagnosed and treated in the Affiliated Hospital of Inner Mongolia Medical University were collected from January 2015 to January 2018. According to the pulmonary artery pressure, they were divided into four groups, including 16 cases in the no PAH group, 16 cases in the mild PAH group, 14 cases in the moderate PAH group, and 14 cases in the severe PAH group. Preoperative transthoracic echocardiography was used to estimate the pulmonary artery systolic blood pressure, and the changes in plasma NT-proBNP concentrations at different times before and after the operation in children with different degrees of PAH were compared. Results The overall comparison of NT-proBNP levels before and after in the four groups was statistically significant (P ＜ 0.05). Among them, there was no significant difference in plasma NT-proBNP levels between the no-PAH group and the mild PAH group (P ＞ 0.05); the plasma NT-proBNP levels in the severe and moderate PAH groups were higher than those in the no PAH group and the mild PAH group, and the differences were statistically significant (P ＜ 0.05); the plasma NT-proBNP level in the severe PAH group was lower than that in the moderate PAH group, and the difference was statistically significant (P ＜ 0.05). The level of NT-proBNP in the mild PAH group after operation was higher than that before operation, and the difference was statistically significant (P ＜ 0.05). Conclusion In clinical studies, the plasma NT-proBNP level before and after surgery in children with congenital heart disease with left-to-right shunt gradually increases with the severity of PAH, which can be used as an indicator to evaluate the degree of PAH and help protect the health of patients, it is worth applying in practice.

Key words： Brain natriuretic peptide Congenital heart disease Pulmonary hypertension Clinical significance

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引用本文:

郭俊晓任杰▲ 张玉龙刘志平. 先天性心脏病合并不同程度肺动脉高压患儿手术前后血浆脑钠肽前体的变化[J]. 中国医药导报, 2021, 18(2): 56-60.
GUO Junxiao REN Jie▲ ZHANG Yulong LIU Zhiping. Changes of plasma pro-brain natriuretic peptide before and after operation in children with congenital heart disease with different degrees of pulmonary hypertension. 中国医药导报, 2021, 18(2): 56-60.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2021/V18/I2/56

[1] 刘路.64层螺旋CT在小儿复杂型先天性心脏病中的诊断价值[J].贵州医药，2018，42（10）：1262-1263.
[2] Gosnell J，Pietila T，Samuel BP，et al. Integration of Computed Tomography and Three-Dimensional Echocardiography for Hybrid Three-Dimensional Printing in Congenital Heart Disease [J]. J Digit Imaging，2016，29（6）：665-669.
[3] 杨正兵，张利兵，闫焕，等.儿童复杂性先天性心脏病超声心动图、MSCT检查效果及其应用临床价值分析[J].中国CT和MRI杂志，2019，17（9）：70-72，94.
[4] Inglessis I，Landzberg MJ. Interventional catheterization in adult congenital heart disease [J]. Circulation，2007，115（12）：1622-1633.
[5] Diller GP，Gatzoulis MA. Pulmonary vascular disease in adults with congenital heart disease [J]. Circulation，2007， 115（8）：1039-1050.
[6] Abel E，JanKowski A，Pison C，et al. Pulmonary artery and right ventricle assessment in pulmonary hypertension：correlation between functional parameters of ECG-gated CT and right-side heart catheterization [J]. Acta Radiol，2012，53（7）：720-727.
[7] Galiè N，Hoeper MM，Humbert M，et al. Guidelines for the diagnosis and treatment of pulmonary hypertension：the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology （ESC） and the European Respiratory Society （ERS），endorsed by the International Society of Heart and Lung Transplantation （ISHLT） [J]. Eur Heart J，2009，30（20）：2493-2537.
[8] Hori Y，Uchide T，Saitoh R，et al. Diagnostic utility of NT-proBNP and ANP in a canine model of chronic embolic pulmonary hypertention [J]. Vet J，2012，194（2）：215-221.
[9] Quezada-Loaiza CA，Flox-Camacho A，Santos-Lozano A，et al. Predictive value of NT-proBNP combined with exercise capacity variables in pulmonary artery disease：insights from a Spanish cohort [J]. Int J Cardiol，2015，186（3）：32-34.
[10] Currie PJ，Seward JB，Chan KL，et al. Continuous wave Doppler determination of right ventricular pressure：a simultaneous Doppler-catheterization study in 127 patients [J]. J Am Coll Cardiol，1985（6）：750-756.
[11] Zwijnenburg RD，Baggen VJM，Geenen LW，et al. The prevalence of pulmonary arterial hypertension before and after atrial septal defect closure at adult age：a systematic review [J]. J Am Heart，2018，201（4）：63-71.
[12] van Riel AC，Blok IM，Zwinderman AH，et al. Lifetime risk of pulmonary hypertension for all patients after shunt closure [J]. J Am Coll Cardiol，2015，66（9）：1084-1086.
[13] 李红英，张会军，黄建成，等.成人先天性心脏病合并重度肺动脉高压患者手术前后血浆N端脑利钠肽前体水平的变化[J].实用医学杂志，2016，11（32）：1829-1831.
[14] 田晓瑜，王晓宁，陈惠芬，等.儿童先天性心脏病手术前后血浆脑钠肽的变化[J].河北医药，2014，36（1）：168-171.
[15] 林春秋，蒋文秀，邱婷，等.心力衰竭新生儿血浆B型脑钠肽和N末端B型脑钠肽前体水平检测的临床意义[J].中国医药，2020，15（4）：495-499.
[16] 王朝晖.心脏瓣膜置换术围术期患者血浆NT-proBNP水平检测及其预后评估[J].中国现代医生，2019，57（35）：48-50，54.
[17] Mair J. Biochemistry of B-type natriuretic peptide-where are we now [J]. Clin Chem Lab Med，2008，46（11）：1507-1514.
[18] Badesch DB，Champion HC，Sanchez MA，et al. Diagnosis and assessment of pulmonary arterial hypertension [J]. J Am Coll Cardiol，2009，54（Suppl 1）：S55-S66.
[19] Shen WK，Sheldon RS，Benditt DG，et al. 2017 ACC/AHA/HRS，guideline for the evaluation and management of patients with syncope：A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines，and the Heart Ｒhythm Society [J]. J Am Coll Cardiol，2017，70（5）：39-110.
[20] Ponikowski P，Voors AA，Anker SD，et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [J]. Eur J Heart Fail，2016，18（8）：128.
[21] Ancion A，D’Orio V，Lancellotti P. European Society of Cardiology guidelines for the management of chronic heart failure [J]. Rev Med Liege，2017，72（2）：68.
[22] 高艺花.成人先天性心脏病伴肺动脉高压患者超声心动图右心室功能指标和血浆N端脑利钠肽前体的相关性研究[J].中国现代医学杂志，2015，25（1）：74-77.
[23] 郭志强，蓝健，王云，等.ICU重症心力衰竭患者的血浆脑钠肽表达及对患者预后的影响研究[J].中国医药科学，2019，9（18）：202-205.
[24] 张莉，张洁，杨荣，等.先天性心脏病患者介入治疗前后血浆N端脑利钠前体和cTnT的变化[J].江苏医药，2015， 41（7）：762-764.
[25] Takatsuki S，Wagner BD，Ivy DD. B-type natriu reticpeptide and amino-terminal pro-B-type natriuretic peptide inpediatric patients with pulmonaryarterial hypertension [J]. Congenit Heart Dis，2012，7（3）：259-267.
[26] 李亚清，严建平，许武，等.双水平气道正压通气对老年慢性肺源性心脏病合并二型呼吸衰竭患者血浆N-端脑利钠肽前体水平的影响[J].中华老年医学杂志，2014， 33（11）：1157-1160.
[27] Cantinotti M，Passino C，Storti S，et al. Clinical relevance of time course of BNP levels in neonates with congenital heart disease [J]. Clin Chim Acta，2014，412（23/24）：2300-2304.
[28] Cantinotti M，Vittorini S，Storti S，et al. Diagnostic accuracy and clinical relevance of brain natriuretic peptide assay in pediatric patients with congenital heart diseases [J]. J Cardiovasc Med （Hagerstown），2009，10（9）：706-713.
[29] 崔华，胡亦新，封志纯.先天性心脏病PAH患儿左室舒张功能与血浆脑利钠水平的相关性研究[J].中国当代儿科杂志，2010，12（1）：13-16.