室间隔缺损患儿介入治疗前后血浆降钙素基因相关肽水平的变化及其与心功能的关系﹡

摘要

目的：观察室间隔缺损患儿介入治疗前后血浆降钙素基因相关肽水平的变化，结合超声心动图，探讨血浆降钙素基因相关肽水平的变化及其与心功能的关系。　　方法：选择2011-09至2012-09在我院心内科行介入治疗成功的90例室间隔缺损患儿作为室间隔缺损组，男43例，女47例，年龄3~12岁。选取同期年龄及性别与之相匹配的体检健康儿童50例为健康对照组。在介入术前及术后24小时、3天、5天、3个月采集静脉血测定血浆降钙素基因相关肽水平；并查超声心动图，测定：左心室舒张末前后径（LVEDD）、左心室收缩末前后径（LVESD）、左心室舒张末容量（LVEDV）、左心室收缩末容量（LVESV）、左心室射血分数。分析血浆降钙素基因相关肽与心功能指标的相关性。　　结果：室间隔缺损组术前降钙素基因相关肽浓度低于健康对照组，差异有统计学意义[（35.28±7.25）pg/ml vs （50.90±8.60）pg/ml，t=11.42，P<0.01]。介入术后室间隔缺损组各时间点降钙素基因相关肽浓度均较术前升高，术后24小时达高峰，术后3天开始下降。术前降钙素基因相关肽浓度与术后24小时、术后3天、术后5天比较差异有统计学意义[（35.28±7.25）pg/ml vs（102.03±11.73）pg/ml；（35.28±7.25）pg/ml vs（93.36±9.12）pg/ml；（35.28±7.25） pg/ml vs（87.91±8.54）pg/ml；t=27.03、26.93、24.51，P均<0.01]。介入术后5天、3个月及6个月LVEDD、LVESD、LVEDV、LVESV较介入术前均明显减小，差异均有统计学意义（P均<0.05~0.01），而左心室射血分数差异无统计学意义。室间隔缺损组在介入术前及介入术后5天、3个月血浆降钙素基因相关肽水平与LVEDD、LVESD、LVEDV、LVESV相关关系显著（P均<0.05），差异均有统计学意义。　　结论：室间隔缺损患儿介入术后血浆降钙素基因相关肽水平的变化与心室腔径变化密切相关，对评估室间隔缺损患儿介入治疗后血流动力学、房室结构重塑逆转以及心功能变化具有重要意义。%Objective: To explore the relationship between plasma levels of calcitonin gene related peptide (CGRP) and cardiac function in ventricular septal defect (VSD) children before and after the interventional therapy. Methods: Our research included 2 groups:VSD group, n=90 containing 43 male and 47 female at the age of (3-12) years and treated in our hospital from 2011-09 to 2012-09, Control group, n=50 healthy children with matched age and gender. The levels CGRP were measured at before and 24 hours, 3 days, 5 days, 3 months after the therapy. The cardiac function as left ventricle end-diastolic diameter (LVEDD), left ventricle end systolic diameter (LVESD), left ventricle end diastolic volume (LVEDV), left ventricle end systolic volume (LVESV) and ejection fraction (EF) were examined by echocardiography at before and after the procedure. Results: Before interventional procedure, the level of CGRP in VSD group was lower than Control group (35.28 ± 7.25) pg/ml vs (50.90 ± 8.60) pg/ml, t=11.42, P<0.01. In VSD group, the post-procedural levels of CGRP were increased at all time points, the highest level was at 24 hours and the descending started at 3 days after procedure;the levels of CGRP at before and 24 hours, 3 days, 5 days after the procedure were different as (35.28 ± 7.25) pg/ml vs (102.03 ± 11.73) pg/ml, (35.28 ± 7.25) pg/ml vs (93.36 ± 9.12) pg/ml, (35.28 ± 7.25) pg/ml vs (87.91 ± 8.54) pg/ml, t=27.03, 26.93, 24.51, all P<0.01. In VSD group, the LVEDD, LVESD, LVEDV and LVESV decreased gradually at 5 days, 3 months and 6 months after the procedure;the levels of CGRP were signiifcantly related to LVEDD, LVESD, LVEDV, LVESV at before and 5 days, 3 months after the procedure, all P<0.05. Conclusion: Plasma levels of CGRP closely related to ventricular cavity diameter, which was important for evaluating the cardiac function in VSD children after the interventional therapy.