主动脉缩窄患儿术后发生血压升高的机制研究  

Mechanism of elevated blood pressure in pediatric patients with repaired CoA

作　　者：曾洁敏 黄萍 王红英 施婷婷 冯浩然 印根权 金颖康 卢根 Zeng Jiemin;Huang Ping;Wang Hongying;Shi Tingting;Feng Haoran;Yin Genquan;Jin Yingkang;Lu Gen(Department of Respiratory,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China;Heart Center,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China;Department of Ultrasound,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China;Central Lab,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心儿童呼吸内科,510623 [2]广州市妇女儿童医疗中心儿童心脏中心,510623 [3]广州市妇女儿童医疗中心儿童超声科,510623 [4]广州市妇女儿童医疗中心中心实验室,510623

出　　处：《中华胸心血管外科杂志》2021年第10期579-585,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨主动脉缩窄(coarctation of the aorta,CoA)患儿术后血压升高的机制。方法选取2010年1月至10月期间23例CoA患儿,选取同时期年龄、性别相仿的20例单纯室间隔缺损(ventricular septal defect,VSD)患儿与20例健康儿童作对照,于基线(术前1天)、8年随访(术后8年)中监测血压、超声下颈总动脉内中膜厚度(carotid intima-media thickness,CIMT)、血清转化生长因子β1(transforming growth factor-β1,TGF-β1)。结果术前3组的收缩压、舒张压差异无统计学意义(P>0.05)。术后8年CoA组出现2例高血压,且CoA组收缩压高于VSD组和健康组(P<0.05)。术前和术后8年CoA组的CIMT、血清TGF-β1分别高于同期的VSD组和健康组(P<0.05)。CoA组术前的CIMT和血清TGF-β1分别与术后8年的收缩压有高度的正相关性(P<0.05)。结论CoA患儿在术后的中、长期随访中出现血压升高,可能与TGF-β信号通路参与的血管重塑有关。术前监测CoA患儿的CIMT和TGF-β1可能对其术后收缩压水平的预测有一定意义。Objective To monitor the blood pressure in pediatric patients with coarctation of the aorta(CoA)before and 8 years after surgery,and explore the mechanism of elevated blood pressure in pediatric patients with repaired CoA.Methods A cohort of 23 pediatric patients who underwent CoA repair between January 2010 and October 2010 in Guangzhou Women and Children's Medical Center was studied.And 20 age-,sex-match patients with isolated ventricular septal defect(VSD)who underwent surgery at the same time,20 age-,sex-match health patients with normal echocardiographic findings were included in the study.Systolic blood pressure(SBP),diastolic blood pressure(DBP),arm-leg SBP gradient,right carotid intima-media thickness(CIMT),serum transforming growth factor-β1(TGF-β1)were monitored at baseline(1 day before surgery)and 8-year follow-up(8 years after surgery).Results There were no differences in SBP and DBP among patients with CoA,patients with VSD and health children at baseline(P>0.05).But at 8-year follow-up,2 patients with CoA exhibited hypertension.Not only that,patients with CoA had higher SBP than patients with VSD and health children at 8-year follow-up(P<0.05).Patients with CoA had higher arm-leg SBP gradient than patients with VSD and health children at baseline(P<0.01).But there were no differences in arm-leg SBP among patients with CoA,patients with VSD and health children at 8-year follow-up(P>0.05).Patients with CoA had increased CIMT and higher serum levels of TGF-β1 at baseline and 8-year follow-up(P<0.05).The preoperative levels of CIMT and serum TGF-β1 in the patients with CoA were highly positively correlated with their levels at 8-year follow-up,respectively(P<0.01).There was a strong correlation between the levels of CIMT and serum TGF-β1 in patients with CoA,both preoperatively and postoperatively(P<0.01).The preoperative and postoperative levels of CIMT and serum TGF-β1 in the patients with CoA were highly positively correlated with SBP at 8-year follow-up,respectively(P<0.05).Conclusion Although

关 键 词：主动脉缩窄 血压 颈总动脉内中膜厚度 血清转化生长因子Β1 

分 类 号：R726.5[医药卫生—儿科]