先天性心脏病合并肺动脉高压患儿肿瘤坏死因子样凋亡微弱诱导剂的表达及意义  

Expression and significance of tumor necrosis factor-like weak inducer of apoptosis in children with congenital heart disease and pulmonary arterial hypertension

作　　者：蔡腾 仇杰[1] 卢一品 杨成会 刘宏生[1] CAI Teng;QIU Jie;LU Yipin;YANG Chenghui;LIU Hongsheng(Department of Cardiology Intensive Medicine,The Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院心脏重症医学科,272029 [2]济宁医学院临床医学院

出　　处：《心肺血管病杂志》2020年第9期1057-1061,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：济宁医学院附属医院“苗圃”科研计划项目(MP-2017-019);济宁医学院教师科研扶持基金(JYFC2019KFJ059)。

摘　　要：目的:探讨先天性心脏病合并肺动脉高压(CHD-PAH)患儿,肿瘤坏死因子样凋亡微弱诱导剂(TWEAK)的表达和意义。方法:选取2018年6月至2019年6月,于济宁医学院附属医院心脏外科手术的CHD患儿38例,根据肺动脉压力,分为先天性心脏病合并肺动脉高压组(CHD-PAH组,n=27)和先天性心脏病不合并肺高压组(CHD-control组,n=11),收集患儿术后第1天危重评分、机械通气时间、ICU停留时间、术后氧合情况和住院天数等临床指标;采用酶联免疫吸附法(ELISA)检测并比较两组患儿外周血TWEAK水平变化,并分析其与早期预后指标的相关性。结果:CHD-PAH组患儿外周血TWEAK水平比CHD-control组低,两组比较差异有统计学意义(Z=-3.735,P=0.001)。CHD患儿外周血TWEAK水平与术后PaO2成正相关性(r=0.570),与术后危重评分呈正相关性(r=0.507),与术后机械通气时间呈负相关性(r=-0.600),与术后ICU停留时间呈负相关性(r=-0.618),与术后住院天数呈负相关性(r=-0.404),均差异有统计学意义(均P<0.05)。结论:TWEAK在CHD-PAH患儿中表达水平下降,且与术后早期预后指标显著相关,可作为评估先天性心脏病患者术后严重程度的参考指标。Objective:To investigate the expression and significance of tumor necrosis factor-like weak inducer of apoptosis(TWEAK)in children with congenital heart disease complicated with pulmonary arterial hypertension(CHD-PAH).Methods:38 children with CHD were selected from June 2018 to June 2019 in Department of Cardiac Surgery,the Affiliated Hospital of Jining Medical University.According to the pulmonary artery pressure,the children were divided into congenital heart disease with pulmonary hypertension group(CHD-PAH group,n=27)and congenital heart disease with normal pulmonary pressure group(CHD-control group,n=11).The critical score on the first day after surgery,mechanical ventilation time and ICU stay time,postoperative oxygenation and hospitalization days and other clinical indicators were collected.Enzyme linked immunosorbent assay(ELISA)was used to detect and compare peripheral blood TWEAK level changes in the two groups,and to analyze its correlation with early prognostic indicators.Results:The level of peripheral blood TWEAK in CHD-PAH group was lower than that in CHD-control group,and the difference between the two groups was statistically significant(Z=-3.735,P=0.001).There were positive correlation between peripheral blood TWEAK level and postoperative PaO2,critical score in children with CHD(r=0.570,0.507),all had statistical significance(all P<0.05).There were negatively correlation between peripheral blood TWEAK level and postoperative tracheal intubation time,ICU stay time,hospitalization days(r=-0.600,-0.618,-0.404),all had statistical significance(all P<0.05).Conclusions:The expression level of TWEAK is decreased in CHD-PAH children,and it is significantly correlated with the early prognosis index,which can be used as a reference index to evaluate the postoperative severity of CHD.

关 键 词：先天性心脏病 肺动脉高压 肿瘤坏死因子样凋亡微弱诱导剂 预后 

分 类 号：R54[医药卫生—心血管疾病]