CAJ | 학술논문

[目的]探讨成人先天性心脏病（CHD）并肺动脉高压（PAH）患者血浆中血管内皮生长因子（VEGF）和转化生长因子-β1TGF-β1）的浓度水平在疾病过程中的临床意义及价值。[方法]选择本院心内科、心胸外科收治的78例成人左向右分流型CHD患者均在右心导管检查中直接测定肺动脉平均压（ mPAP ），按 mPAP水平分为无PAH组（ mPAP ≤25 mm-Hg）20例、轻度 PAH组（25 mmHg ＜ mPAP≤35 mmHg）21例、中度PAH组（35 mmHg ＜ mPAP≤45 mmHg）14例及重度 PAH组（ mPAP ＞45 mmHg）23例。取患者主肺动脉血。选择同期心内科收治的预行射频消融术患者10例为正常对照组。对照组于清晨空腹状态下行射频消融术时抽股静脉血4ml。采用酶联免疫吸附法（ELISA ）测定其肺动脉血浆VEGF及 TGF-β1水平，分析二者与 mPAP的关系。[结果]CHD组血浆VEGF及 TGF-β1均显著高于对照组（ P ＜0．01）。四组患者肺动脉血浆 VEGF水平和TGF-β1水平组间比较差异均有统计学意义（F＝449．078，P＜0．05），（F＝57．347，P＜0．05）；肺动脉血浆 VEGF浓度水平与 mPAP呈正相关（ r ＝0．814，P＜0．05）；肺动脉血浆TGF-β1浓度水平与mPAP呈正相关（ r ＝0．723，P＜0．05）；患者血浆VEGF与TGF-β1水平呈正相关（ r ＝0．758，P＜0．05）。[结论]VEGF及TGF-β1参与了左向右分流型 CHD并 PAH的病理生理过程，其血浆水平可作为评估左向右分流型CHD患者PAH严重程度的参考指标之一。VEGF及TGF-β1对监测PAH发生发展动态变化过程有一定意义及临床价值。
[목적]탐토성인선천성심장병（CHD）병폐동맥고압（PAH）환자혈장중혈관내피생장인자（VEGF）화전화생장인자-β1TGF-β1）적농도수평재질병과정중적림상의의급개치。[방법]선택본원심내과、심흉외과수치적78례성인좌향우분류형CHD환자균재우심도관검사중직접측정폐동맥평균압（ mPAP ），안 mPAP수평분위무PAH조（ mPAP ≤25 mm-Hg）20례、경도 PAH조（25 mmHg ＜ mPAP≤35 mmHg）21례、중도PAH조（35 mmHg ＜ mPAP≤45 mmHg）14례급중도 PAH조（ mPAP ＞45 mmHg）23례。취환자주폐동맥혈。선택동기심내과수치적예행사빈소융술환자10례위정상대조조。대조조우청신공복상태하행사빈소융술시추고정맥혈4ml。채용매련면역흡부법（ELISA ）측정기폐동맥혈장VEGF급 TGF-β1수평，분석이자여 mPAP적관계。[결과]CHD조혈장VEGF급 TGF-β1균현저고우대조조（ P ＜0．01）。사조환자폐동맥혈장 VEGF수평화TGF-β1수평조간비교차이균유통계학의의（F＝449．078，P＜0．05），（F＝57．347，P＜0．05）；폐동맥혈장 VEGF농도수평여 mPAP정정상관（ r ＝0．814，P＜0．05）；폐동맥혈장TGF-β1농도수평여mPAP정정상관（ r ＝0．723，P＜0．05）；환자혈장VEGF여TGF-β1수평정정상관（ r ＝0．758，P＜0．05）。[결론]VEGF급TGF-β1삼여료좌향우분류형 CHD병 PAH적병리생리과정，기혈장수평가작위평고좌향우분류형CHD환자PAH엄중정도적삼고지표지일。VEGF급TGF-β1대감측PAH발생발전동태변화과정유일정의의급림상개치。
[Objective]To explore the levels of plasma vascular endothelial growth factor (VEGF) and transform growth factor-β1(TGF-β1) in adult patients with congenital heart disease(CHD) and pulmonary arterial hypertension(PAH) and their clinical significance and value .[Methods]A total of 78 adult patients with left-to-right shunt type CHD admitted in cardiology department and thoracic surgery department were chosen .According to mean pulmonary artery pressure (mPAP) directly de-tected by right heart catheterization ,all patients were divided into non-PAH group(mPAP≤25mmHg ,n = 20) ,mild PAH group(25mmHg<mPAP≤35mmHg ,n=21) ,moderate PAH group(35mmHg<mPAP≤45 mmHg ,n=14) and severe PAH group (mPAP>45mmHg ,n=23) .Pulmonary artery blood was collected .Other 10 concurrent patients scheduled for radiofre-quency ablation in cardiology department was chosen as normal control group .When radiofrequency ablation was performed un-der fasting status in the morning ,femoral venous blood 4ml in control group was drawn .The levels of VEGF and TGF-β1 were measured by using enzyme linked immunosorbent assay (ELISA) .The relationship of VEGF and TGF-β1 with mPAP was ana-lyzed .[Results]The levels of plasma VEGF and TGF-β1 in CHD group were significantly higher than those in control group( P<0 .01) .There were significant differences in the levels of plasma VEGF and TGF-β1 in pulmonary artery among four groups (F=449 .078 ,P <0 .05 or F=57 .347 ,P <0 .05) .The level of plasma VEGF in pulmonary artery was positively correlated with mPAP(r=0 .814 ,P <0 .05) .The level of plasma TGF-β1 in pulmonary artery was positively correlated with mPAP (r=0 .723 ,P<0 .05) .The level of plasma VEGF was positively correlated with the level of TGF-β1(r=0 .758 ,P<0 .05) .[Con-clusion]VEGF and TGF-β1 involve in the physiological processes of CHD combined with PAH .The level of VEGF and TGF-β1 can be taken as one of the indicators to evaluate the severity of PAH in patients with left-to-right shunt type CHD .VEGF and TGF-β1 are of certain significance and clinical value for monitoring the dynamic change process of the occurrence and devel-opment of PA H .