儿童先天性心脏病介入治疗前、后心肌损伤的研究

摘要

Objective To investigate the myocardial damage in congenital heart diseases after paediatric cardiovascular intervention by the made-in-China occluder through monitoring the changes of heart fatty acid-binding protein (H-FABP)and cardiac troponin I (cTnl)dynamically. Methods A total of 24 patent ductus arteriosus (PDA)patients, 20 atrial septal defect (ASD)patients and 16 ventricular septal defect (VSD)patients were enrolled, and their serum levels of cTnl and H-FABP were monitored dynamically. Results The results of serum H-FABP and cTnl concentrations were 1. 28 ± 0. 57 μg/L and 0. 02 ± 0. 01 μg /L at preoperative time, respectively. After the operation, they were 8.51 ±5.47 μg/L and 0.46 ±0.49 μg/L after (10±5)min, and 2.31 ±1.73 μg/L and 0.66 ± 0.45 μg/L after 4 h, respectively, and then they were decreased obviously after 24 h with statistical significance (P < 0.01). Conclusions After paediatric cardiovascular intervention, it exists myocardial damage which is related to the kinds of congenital heart diseases. Compared with cTnl, the serum H-FABP is an early and sensitive marker for predicting myocardial damage. It is useful to prevent postoperative complications by monitoring H-FABP and cTnl.%目的 通过动态监测血清心肌型脂肪酸结合蛋白(H-FABP)和心肌肌钙蛋白Ⅰ(cTnI),观察使用国产封堵器介入治疗先天性心脏病时心肌损伤的情况.方法 随机选取动脉导管未闭(PDA) 24例、房间隔缺损( ASD) 20例、室间隔缺损(VSD) 16例,动态监测cTnI、H-FABP的变化.结果 60例先天性心脏病患儿血清H-FABP、cTnI术前浓度平均分别为1.28±0.57 μg/L、0.02±0.01 μg/L；术后(10±5)min分别为8.51±5.47 μg/L、0.46±0.49 μg/L,术后4h分别为2.31±1.73 μg/L、0.66±0.45 μg/L,24 h明显下降,各时间点差异有统计学意义(P＜0.01).结论 先天性心脏病介入治疗存在心肌损伤,并与先天性心脏病类型有一定关系.H-FABP较cTnI更早出现峰值浓度,是早期判断心肌损伤的理想指标,测量cTnI、H-FABP可为临床防治术后并发症提供科学依据.