心力衰竭患儿血浆神经生长因子水平及卡托普利的干预研究

摘要

Objective To study the levels of plasma nerve growth factor( NGF ) in children with congestive heart failure ( CHF ) and its changes after treatment of captopril. Methods 25 children with CHF were randomly divided into 2 groups:ordinary regimen group( n= 12 ) and captopril treatment one ( n= 13 ). The plasma concentration of norepinephrin( NE ) and nerve growth factor were measured by high performance liquid chromatography and a two-site enzyme-linked immunosorbent assay ( ELISA ), respectively. 20 healthy children were selected as controls. Digoxin, diuretics and the vasodilatation agent were given as conventional treatment. Catto Pulley was added besides the conventional treatment, to the young children 1 ～ 2 mg · kg -1 · d- 1 ,bid for 3 months. Results ①Plasma concentrations of NE were markedly increased and NGF were decreased significantly in CHF group, compared with those in the normal control group; There was correlation between the levels of NE, NGF and cardiac function, and a negative correlation between NGF and NE( r=-0.771 ,P＜0.01 ). ②3 months after therapy, the levels of NE in ordinary regimen group were significantly decreased( P ＜ 0. 01 ), NGF were increased ( P ＜ 0.05 ), there was no significant difference in ejection fraction( EF )levels compared with those before treatment ( P＞0.05 ); In captopril regimen group, the levels of NE were significantly decreased( P＜0.01 ), NGF and EF were significantly increased ( P＜0.01 ); There were significant differences between two groups in the levels of NE, NGF and EF after treatment ( P＜0.01 ). ③The cardiac function was improved in both groups, especially in the captipril treated group after 3 months( P＜0.01 ). Conclusion NGF are involved in the process of CHF, captopril can prevent and reverse the neurohumoral disorders in CHF and improve the cardiac function of children with CHF.%目的 探讨心力衰竭患儿血浆神经生长因子(nerve growth factor,NGF)水平变化及卡托普利对其影响.方法 将25例心力衰竭患儿随机分为常规组12例和卡托普利组13例,酶联免疫吸附试验检测血浆NGF水平变化,高效液相色谱-电化学法检测血浆去甲肾上腺素(norepinephrin,NE)水平,并以20例正常儿童作为对照组.常规组给予地高辛、利尿药及血管扩张药;卡托普利组在常规治疗的基础上加用卡托普利1～2 mg·kg-1·d-1,bid,连续治疗3个月.结果 ①心力衰竭组血浆NE水平较正常对照组明显升高,NGF水平明显降低,均差异有统计学意义(P＜0.01);两者水平与心功能相关;血浆NGF水平与NE水平呈负相关(r=-0.771,P＜0.01).②与治疗前比较,常规组血浆NE水平明显降低(P＜0.01),NGF水平升高(P＜0.05),射血分数(ejection fraction,EF)无明显变化(P＞0.05);卡托普利组血浆NE水平明显降低,差异有统计学意义(P＜0.01),NGF、EF水平明显升高,均差异有统计学意义(P＜0.01).卡托普利组与常规组治疗后比较,均差异有统计学意义(P＜0.01).③常规组与卡托普利组治疗3个月后,心功能分级均有不同程度降低,后者降低更明显,两组差异有统计学意义(P＜0.01).结论 NGF参与了心力衰竭发病的病理生理机制,卡托普利可能从根本上防止和逆转心力衰竭时的异常神经激素,使患儿的心功能明显改善.