先天性心脏病患者系统性炎症与肺动脉高压的相关性研究  

Relation Study on Systemic Inflammation in Congenital Heart Disease and Pulmonary Artery Hypertension

作　　者：郑华[1] 李洁[1] 吕亚辉[1] 王颖[1] 边红[1] 

机构地区：[1]首都医科大学附属北京同仁医院心血管中心,北京100730

出　　处：《中国医药导刊》2016年第2期156-158,共3页Chinese Journal of Medicinal Guide

摘　　要：目的:通过观察CHD合并PAH患者常见临床炎症指标的变化,探讨炎症是否与CHD患者肺动脉压力有相关性。方法:CHD患者,排除其他可能影响炎症因子水平的疾病。在病情稳定状态下行右心导管检查,测定肺动脉收缩压(s PAP)。采用SPSS13.0对数据进行分析。符合正态分布检验的数据以独立样本t检验进行统计分析;不符合正态分布的计量资料行秩和检验进行分析。采用多元线性回归方法分析炎症因子与肺动脉压力的相关性。结果:两组患者的年龄,性别,体重指数具有可比性。单核细胞计数(P=0.003)和尿酸水平(P=0.001)升高。两组hs-CRP中位数水平(1.45mg/L vs 0.47mg/L,P=0.009)有明显差异。经过逐步回归分析,血液单核细胞数和经对数转换后的hs-CRP是s PAP的独立预测因子(校正的R2=0.315,单核细胞数:P=0.021;对数转换的hs-CRP:P=0.001)。结论:先天性心脏病患者中,hs-CRP,单核细胞计数在合并PAH患者中明显升高,并与肺动脉收缩压相关。Objective: Studies showed that inflammation may play an important role in PAH.In primary and secondary PAH,the walls of small pulmonary arteries of the patients are commonly infiltrated by inflammatory cells,which associated with both an impaired endothelium-dependent artery relaxation and the thickening of the intimal layer.However,no data on the potential role of systemic inflammation in pulmonary hypertension secondary to congenital heart disease(CHD) are available.Therefore, our aim was to investigate the inflammation in CHD patients with and without pulmonary hypertension.Methods:In 99 patients with CHD(ASD, VSD), pulmonary artery pressure(Ppa) levels were measured by pulmonary artery catheterization. Serum high-sensitivity CRP(hs-CRP)levels were measured by chemiluminescent immunoassay.Results:Pulmonary hypertension was present in 44 patients and was absent in 55 patients. In patients with pulmonary hypertension, the level of serum uric acid and monocyte counts was significantly higher than in those patients without hypertension, and hs-CRP level was also increased in patients with PAH(median, 1.45mg/L vs 0.47 mg/L,P=0.009). In multiple linear regression analysis, two variables were independent predictors of systolic PAP(R2= 0.315):monocyte counts(P=0.021); and log-transformed serum hs-CRP level(P=0.001).Conclusion:We conclude that increases in Ppa in patients with CHD are associated with higher serum levels of hs-CRP and monocyte counts, raising the possibility of a pathogenetic role for low-grade systemic inflammation in the pathogenesis of pulmonary hypertension in CHD patients.

关 键 词：先天性心脏病 C反应蛋白 尿酸 单核细胞计数 肺动脉压 

分 类 号：R541.1[医药卫生—心血管疾病] R544.1[医药卫生—内科学]