【摘要】 目的了解小儿心脏病患者血浆氨基末端脑利钠肽(brainnatriureticpeptide,BNP)前体(N-pro-BNP)水平与心功能的关系及其在介入治疗前后的变化。方法收集自2004年7月至2005年1月间左向右分流先天性心脏病患儿共58例,所有患儿在介入治疗前后均进行心功能分级的临床评价,通过二维超声心动图测定射血分数(EF)、缩短分数(FS)、左心室舒张末期内径(LVDd)及N-pro-BNP水平,比较介入前后的改变。结果58例均成功接受介入治疗。介入治疗前后LVDd,EF,FS和血浆N-pro-BNP水平分别为36·7±5·2mm比35·4±4·2mm,78·1%±5·3%比75·3%±6·5%(P<0·05),41·1%±5·4%比38·3%±4·9%(P<0·05),194·7±154·7ng/L比561·0±594·2ng/L(P<0·05)。室间隔缺损(VSD)组术前N-pro-BNP水平(68·7±60·8ng/L)明显低于动脉导管未闭(PDA)+房间隔缺损(ASD)组(277·5±279·5ng/L),VSD组术后N-pro-BNP水平(436·8±793·6ng/L)较术前(68·7±60·8ng/L)明显升高(P<0·05),PDA+ASD组手术前后差异无统计学意义。结论介入治疗后48h内EF和FS有所下降,血浆N-pro-BNP水平则明显升高。VSD组内术后N-pro-BNP水平较术前明显升高,推测可能是操作过程中对左心室反复的机械刺激所致。更多还原

【Abstract】 Objective To investigate the relationship between plasma pro-brain natriuretic peptide (N-pro-BNP) level and heart function, as its well as change before and after interventional therapy. Methods Fifty-eight children with left to right shunt congenital heart diseases were enrolled from July, 2004 to Jan, 2005. Clinical heart function were categorized and plasma N-pro-BNP concentration were detected. The ejection fraction (EF), fractional shortening (FS) and left ventricular and diastolic dimension (LVDd) were measured by two-dimensional echocardiography. The relationship between plasma pro-BNP concentration and the echo parameters, and its change before and after interventional therapy were analyzed. Results The plasma N-pro-BNP concentration, LVDd, EF and FS before and after intervention were 194.7±154.7 ng/L vs 561.0±594.2 ng/L (P<0.05), 36.7±5.2 mm vs 35.4±4.2 mm (P<0.05), 78.1%±5.3% vs 75.3%±6.5% (P<0.05), 41.1%±5.4% vs 38.3%±4.9% (P<0.05), respectively. VSD patients had significantly lower preoperational N-pro-BNP level than those of PDA and ASD patients (68.7±60.8 ng/L vs 277.5±279.5 ng/L, P<0.05). N-pro-BNP level elevated greatly after interventions in VSD patients (436.8±793.6 ng/L vs 68.7±60.8 ng/L, P<0.05). EF and FS decreased while plasma N-pro-BNP concentration increased within a period of 48 hours after interventions. Conclusion N-pro-BNP level elevated greatly after interventions in VSD patients, which may be related to the physical stimulations to the left ventricle by catheters during interventional procedure.更多还原