先天性心脏病并肺动脉高压患儿血清基质金属蛋白酶-1、2与金属蛋白酶组织抑制物-1水平变化的意义  

Changes of Serum Matrix Metalloproteinase-1,2 and Tissue Inhibitor Metalloproteinase-1 in Children with Congenital Heart Disease Complicating Pulmonary Hypertension

作　　者：庞玉生[1] 曾红军 于丽娟[1] 陈荣辉[1] 武艺飞[1] 

机构地区：[1]广西医科大学第一附属医院儿科,南宁530021 [2]柳州市妇幼保健医院儿科,广西柳州545001

出　　处：《实用儿科临床杂志》2008年第1期28-30,共3页Journal of Applied Clinical Pediatrics

基　　金：广西回国人员科学基金项目资助(桂科回0639025)

摘　　要：目的探讨先天性心脏病(CHD)并肺动脉高压(PH)患儿血清基质金属蛋白酶(MMP-1、2)、金属蛋白酶组织抑制物(TIMP-1)水平变化的意义。方法将81例左向右分流型CHD患儿按治疗前肺动脉收缩压(SPAP)分为4组:非PH组16例(SPAP<4.0kPa)、轻度PH组21例(4.0kPa≤SPAP<5.33kPa)、中度PH组21例(5.33kPa≤SPAP<9.33kPa)、重度PH组23例(SPAP≥9.33kPa)。中、重度PH组19例予前列腺素E1(PGE1)治疗,轻、中度24例接受手术治疗。选21例健康体检儿童为健康对照组。用ELISA检测其血清MMP-1、2和TIMP-1水平,并计算MMP-1/TIMP-1、MMP-2/TIMP-1比值。结果CHD组MMP-1、2与健康对照组比较均显著增高,并PH后TIMP-1显著增高(Pa<0.05)。非PH、轻和中度PH组MMP-2/TIMP-1与对照组比较均显著增高(Pa<0.05);MMP-1/TIMP-1与对照组比较均无统计学差异(Pa>0.05)。19例经PGE1治疗14d后,MMP-1、2和TIMP-1与治疗前比较均显著下降(Pa<0.01)。24例手术治疗1周后,MMP-1、2、TIMP-1和MMP-2/TIMP-1与术前比较均显著降低(Pa<0.05)。MMP-1与TIMP-1、MMP-1与MMP-1/TIMP-1、MMP-2与MMP-2/TIMP-1均呈显著正相关(Pa<0.05)。结论1.MMP-1、2参与肺血管重构的全过程;2.PGE1可逆转肺血管重构;3.介入治疗、外科手术阻断了CHD异常的血流动力学这一肺血管重构的始动因子。Objective To explore the levels and variation of serum matrix metalloproteinase - 1,2 （ MMP - 1,2） and tissue inhibitor metalloproteinase - 1 （ TIMP - 1 ） in children with congenital heart disease （CHD） complicating pulmonary hypertension （PH）, Methods According to the preoperative pulmonary arterial systolic pressure （SPAP） ,81 patients with CHD were divided into 4 groups：no PH group （ 16 cases,SPAP 〈 4 kPa） ,light PH group （ 21 cases, 4.0 kPa ≤ SPAP 〈 5.33 kPa）, moderate PH group （21 cases, 5, 33 kPa ≤ SPAP 〈 9.33 kPa） and heavy PH group （23 patients, SPAP ≥ 9.33 kPa）. Nineteen patients were comprehensively treated with prostaglandin E1 （ PGE1 ）, Twenty - four patients of the total patients were operated, The concentrations of serum MMP - 1,2 and TIMP - 1 were measured with enzyme linked immunosorbent assay（ELISA）. Then the rates of MMP - 1/TIMP - 1 and MMP -2/TIMP - 1 were calculated, Results The concentrations of serum MMP- 1,2 increased remarkably in CHD groups ,compared with control group（Pa 〈 0.05）. And the level of TIMP- 1 was also significantly advanced in all groups with PH. The rates of MMP-2/TIMP- 1 in the no PH group,light PH and moderate PH group obviously increased（ Pa 〈 0.05）, But there were not obvious changes of the level of MMP - 1/TIMP - 1 whether in the no PH group or in all PH groups （Pa 〉 0, 05 ）. After 19 cases had been treated with PGE1 for 14 days, the levels of MMP- 1,2 and TIMP - 1 remarkably decreased （Pa 〈0. 01 ）, And after 7 days when 24 cases had received surgical intervention,the levels of serum of MMP - 1,2,TIMP - 1 and MMP -2/ TIMP - 1 obviously decreased （ Pa 〈 0.05）, There were positive relationship between MMP - 1 and TIMP - 1, MMP - 1 and MMP - 1/TIMP - 1, MMP - 2 and MMP - 2/TIMP - 1 （Pa 〈 0. 05）, Conclusions 1. The concentrations of serum MMP - 1,2 in patients with CHD of left - to - right shunt type obviously increase. So they may synergistically contribute to pulmonary vascular

关 键 词：心脏病 先天性 肺动脉高压 基质金属蛋白酶 金属蛋白酶组织抑制物 

分 类 号：R725.4[医药卫生—儿科]