先天性心脏病血浆肾上腺髓质素的测定及临床意义  

The significance of the different levels of adrenomedullin in children with congenital heart disease

作　　者：陈欧[1] 王一彪[1] 朱晓波[1] 陈少杰[1] 

机构地区：[1]山东大学第二医院儿科,山东济南250033

出　　处：《中国实用儿科杂志》2008年第3期216-218,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨血浆肾上腺髓质素(ADM)的变化对先天性心脏病病理生理的影响。方法2005年1月至2007年11月筛选在山东大学第二医院儿内科住院的59例先心病患儿,在心导管检查术中测定血流动力学指数及采血备测,依据血流动力学特征分为高肺血流非肺动脉高压组、高肺血流并肺动脉高压组、紫绀组,平均肺动脉压(mPAP)>20mmHg(1mmHg=0.133kPa)为肺动脉高压的标准。选6名正常健康儿童作为对照组。采用特异性放射免疫法检测血浆ADM的水平。结果先心病患儿股静脉中的血浆ADM水平较股动脉明显增高(P<0.05);与对照组相比,高肺血流并肺动脑高压组及紫绀组中的ADM明显增高,均P<0.01;股静脉血浆ADM与主动脉平均压,主动脉血氧饱和度及混合静脉血氧饱和度均呈显著负相关;而与肺血管阻力有显著正相关。结论ADM的变化同肺动脉阻力和缺氧有密切关系,推测ADM水平的升高可能有助于减轻肺动脉阻力和改善缺氧。Objective To investigate the pathophysiological role of adrenomedullin （ ADM ） in congenital heart disease. Methods Fifty-nine children with congenital heart disease were studied, who were hospitalized in the Second Hospital of Shandong University from Jan. 2005 to Nov. 2007. The patients were divided into three groups on the basis of hemodynamic indices measured during cardiac catheterization ： high pulmonary blood flow with （ group A ） or without （ group B ） pulmonary hypertension （mean pulmonary arterial pressure 〉 20mmHg, I mmHg = 0. 133 kPa） and a cyanosis group （without high pulmonary blood flow） （ group C）. Six healthy children were used as a control group. Plasma ADM levels were measured by radioimmunoassay. Results The plasma ADM levels from the femoral vein were significantly higher than those from femoral artery in patients with congenital heart disease （ P 〈 0. 05 ）. The patients from group A and group C had higher plasma ADM levels than the controls（ P 〈0. 01 ）. Plasma ADM levels were significantly negatively correlated with mean systemic arterial pressure, oxygen saturation in mixed vein and oxygen saturation in systemic artery but positively corelated with pulmonary vascular resistance. Conclusion Plasma ADM levels are related to pulmonary arterial resistance and hypoxemia. Increased ADM levels may play a role in reducing the pulmonary arterial resistance and alleviating hypoxemia in these patients.

关 键 词：肾上腺髓质素 先天性心脏病 肺动脉高压 

分 类 号：R72[医药卫生—儿科]