CAJ | 학술논문

目的探讨血浆心房利钠肽(ANP)、内皮素(ET)-1、血管性假血友病因子(vWF)水平在西地那非治疗新生儿持续性肺动脉高压(PPHN)过程中的变化及意义.方法选取PPHN患儿66例(PPHN组)应用西地那非治疗,分别于治疗前和治疗3、7d后采用彩色多普勒超声测定肺动脉收缩压(PASP),并同时检测动脉血气和右手指脉搏血氧饱和度(SpO2),再同时采集静脉血应用酶联免疫吸附法检测ANP、ET-1和vWF水平.各指标与除外心肺相关疾病的非PPHN患儿40例(对照组)进行比较.结果 PPHN组治疗前PASP、SpO2、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)及血浆ANP、ET-1、vWF水平[(66.5±13.4) mm Hg(1 mm Hg=0.133 kPa)、0.726±0.531、(46.3±7.2) mm Hg、(59.2±7.4) mm Hg、(272.6±20.3) ng/L、(221.3±24.3)ng/L、(142.5±20.3)％]与对照组[(25.0±6.2) mm Hg、0.896±0.767、(88.3±7.6) mm Hg、(41.1±6.1) mm Hg、(68.4±7.9)ng/L、(39.8±6.5) ng/L、(95.3±18.5)％]比较差异有统计学意义(P＜0.05);PPHN组治疗3d后各指标[(48.3±3.2) mm Hg、0.841 ±0.416、(73.6±9.3) mm Hg、(50.5±7.2) mm Hg、(102.6±20.3) ng/L、(79.6±15.2) ng/L、(103.6±14.1)％]均明显改善,与治疗前和对照组比较差异有统计学意义(P＜0.05),治疗7d后各指标[(25.2 ±3.6) mm Hg、0.882±0.724、(85.4±7.4) mm Hg、(40.2±6.4) mm Hg、(64.4±3.6)ng/L、(37.3±5.4) ng/L、(92.9±11.7)％]均较治疗3d后明显改善,差异有统计学意义(P＜0.05),与对照组比较差异无统计学意义(P＞0.05).直线相关分析结果显示,治疗前及治疗3、7d后ANP、ET-1、vWF与PASP、PaCO2分别呈显著正相关(P＜0.01),ANP、ET-1、vWF与SpO2、PaO2分别呈显著负相关(P＜0.01).以心脏超声监测PASP为标准做受试者工作特征曲线,ANP、ET-1、vWF评价西地那非疗效的灵敏度分别为82.2％、86.4％、85.1％,特异度分别为83.4％、87.6％、84.7％.结论 ANP、ET-1、vWF可能在西地那非有效治疗PPHN的机制中起重要作用,适时检测PPHN新生儿血浆ANP、ET-1、vWF水平可客观评价西地那非对PPHN的疗效. 目的探討血漿心房利鈉肽(ANP)、內皮素(ET)-1、血管性假血友病因子(vWF)水平在西地那非治療新生兒持續性肺動脈高壓(PPHN)過程中的變化及意義.方法選取PPHN患兒66例(PPHN組)應用西地那非治療,分彆于治療前和治療3、7d後採用綵色多普勒超聲測定肺動脈收縮壓(PASP),併同時檢測動脈血氣和右手指脈搏血氧飽和度(SpO2),再同時採集靜脈血應用酶聯免疫吸附法檢測ANP、ET-1和vWF水平.各指標與除外心肺相關疾病的非PPHN患兒40例(對照組)進行比較.結果 PPHN組治療前PASP、SpO2、動脈血氧分壓(PaO2)、動脈血二氧化碳分壓(PaCO2)及血漿ANP、ET-1、vWF水平[(66.5±13.4) mm Hg(1 mm Hg=0.133 kPa)、0.726±0.531、(46.3±7.2) mm Hg、(59.2±7.4) mm Hg、(272.6±20.3) ng/L、(221.3±24.3)ng/L、(142.5±20.3)％]與對照組[(25.0±6.2) mm Hg、0.896±0.767、(88.3±7.6) mm Hg、(41.1±6.1) mm Hg、(68.4±7.9)ng/L、(39.8±6.5) ng/L、(95.3±18.5)％]比較差異有統計學意義(P＜0.05);PPHN組治療3d後各指標[(48.3±3.2) mm Hg、0.841 ±0.416、(73.6±9.3) mm Hg、(50.5±7.2) mm Hg、(102.6±20.3) ng/L、(79.6±15.2) ng/L、(103.6±14.1)％]均明顯改善,與治療前和對照組比較差異有統計學意義(P＜0.05),治療7d後各指標[(25.2 ±3.6) mm Hg、0.882±0.724、(85.4±7.4) mm Hg、(40.2±6.4) mm Hg、(64.4±3.6)ng/L、(37.3±5.4) ng/L、(92.9±11.7)％]均較治療3d後明顯改善,差異有統計學意義(P＜0.05),與對照組比較差異無統計學意義(P＞0.05).直線相關分析結果顯示,治療前及治療3、7d後ANP、ET-1、vWF與PASP、PaCO2分彆呈顯著正相關(P＜0.01),ANP、ET-1、vWF與SpO2、PaO2分彆呈顯著負相關(P＜0.01).以心髒超聲鑑測PASP為標準做受試者工作特徵麯線,ANP、ET-1、vWF評價西地那非療效的靈敏度分彆為82.2％、86.4％、85.1％,特異度分彆為83.4％、87.6％、84.7％.結論 ANP、ET-1、vWF可能在西地那非有效治療PPHN的機製中起重要作用,適時檢測PPHN新生兒血漿ANP、ET-1、vWF水平可客觀評價西地那非對PPHN的療效.
목적 탐토혈장심방리납태(ANP)、내피소(ET)-1、혈관성가혈우병인자(vWF)수평재서지나비치료신생인지속성폐동맥고압(PPHN)과정중적변화급의의.방법 선취PPHN환인66례(PPHN조)응용서지나비치료,분별우치료전화치료3、7d후채용채색다보륵초성측정폐동맥수축압(PASP),병동시검측동맥혈기화우수지맥박혈양포화도(SpO2),재동시채집정맥혈응용매련면역흡부법검측ANP、ET-1화vWF수평.각지표여제외심폐상관질병적비PPHN환인40례(대조조)진행비교.결과 PPHN조치료전PASP、SpO2、동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2)급혈장ANP、ET-1、vWF수평[(66.5±13.4) mm Hg(1 mm Hg=0.133 kPa)、0.726±0.531、(46.3±7.2) mm Hg、(59.2±7.4) mm Hg、(272.6±20.3) ng/L、(221.3±24.3)ng/L、(142.5±20.3)％]여대조조[(25.0±6.2) mm Hg、0.896±0.767、(88.3±7.6) mm Hg、(41.1±6.1) mm Hg、(68.4±7.9)ng/L、(39.8±6.5) ng/L、(95.3±18.5)％]비교차이유통계학의의(P＜0.05);PPHN조치료3d후각지표[(48.3±3.2) mm Hg、0.841 ±0.416、(73.6±9.3) mm Hg、(50.5±7.2) mm Hg、(102.6±20.3) ng/L、(79.6±15.2) ng/L、(103.6±14.1)％]균명현개선,여치료전화대조조비교차이유통계학의의(P＜0.05),치료7d후각지표[(25.2 ±3.6) mm Hg、0.882±0.724、(85.4±7.4) mm Hg、(40.2±6.4) mm Hg、(64.4±3.6)ng/L、(37.3±5.4) ng/L、(92.9±11.7)％]균교치료3d후명현개선,차이유통계학의의(P＜0.05),여대조조비교차이무통계학의의(P＞0.05).직선상관분석결과현시,치료전급치료3、7d후ANP、ET-1、vWF여PASP、PaCO2분별정현저정상관(P＜0.01),ANP、ET-1、vWF여SpO2、PaO2분별정현저부상관(P＜0.01).이심장초성감측PASP위표준주수시자공작특정곡선,ANP、ET-1、vWF평개서지나비료효적령민도분별위82.2％、86.4％、85.1％,특이도분별위83.4％、87.6％、84.7％.결론 ANP、ET-1、vWF가능재서지나비유효치료PPHN적궤제중기중요작용,괄시검측PPHN신생인혈장ANP、ET-1、vWF수평가객관평개서지나비대PPHN적료효.
Objective To study the changes and significance of plasma atrial natriuretic peptide (ANP),endothehn-1 (ET-1),von Willebrand factor (vWF) levels in newborns with persistent pulmonary hypertension (PPHN) after the treatment of sildenafil.Methods Sixty-six cases with PPHN group and 40 cases with non-PPHN (control group) were enrolled.PPHN group was in the treatment of sildenafil.Collected the blood when before the treatment of sildenafil and 3,7 d after treatment,respectively.Arterial blood gas were done and pulmonary arterial systolic pressure (PASP) was measured before treatment and 3,7 d after treatment,and by the same time recording pulse oxygen saturation (SpO2).Plasma ANP,ET-1,vWF levels were measured by ELISA method.Results The levels of PASP,SpO2 arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2) and plasma ANP,ET-1,vWF in PPHN group before treatment [(66.5 ± 13.4)mm Hg (1 mm Hg =0.133 kPa),0.726 ±0.531,(46.3 ±7.2)mm Hg,(59.2 ± 7.4) mm Hg,(272.6 ± 20.3)ng/L,(221.3 ± 24.3) ng/L,(142.5 ± 20.3)％] compared with controlgroup [(25.0±6.2) mm Hg,0.896 ± 0.767,(88.3 ±7.6) mm Hg,(41.1 ±6.1) mm Hg,(68.4 ± 7.9) ng/L,(39.8 ± 6.5) ng/L,(95.3 ± 18.5)％] were statistically significant(P ＜ 0.05).Their levels in PPHN group 3 dafter treatment[(48.3 ± 3.2) mm Hg,0.841 ± 0.416,(73.6 ± 9.3)mm Hg,(50.5 ± 7.2) mm Hg,(102.6 ±20.3) ng/L,(79.6 ± 15.2) ng/L,(103.6 ± 14.1)％] were significantly improved,there was significantdifference compared with before treatment and control group(P ＜ 0.05).Their levels in PPHN group 7 d aftertreatment [(25.2 ± 3.6) mm Hg,0.882 ± 0.724,(85.4 ± 7.4) mm Hg,(40.2 ± 6.4) mm Hg,(64.4 ± 3.6)ng/L,(37.3 ± 5.4)ng/L,(92.9 ± 11.7)％] were significantly improved,there was significant difference compared with 3 d after treatment (P ＜ 0.05),the difference was no statistically significant compared with control group (P＞ 0.05).Linear correlation analysis showed that ANP,ET-1,vWF and PASP,PaCO2 were significantly positively correlated (P ＜ 0.01),ANP,ET-1,vWF and SpO2,PaO2 were significantly negatively correlated (P＜ 0.01).On the basis of cardiac ultrasound monitoring PASP,ANP evaluation of the efficacy of sildenafil sensitivity was 82.2％,specificity was 83.4％ ;ET-1 was 86.4％ and 87.6％; vWF was 85.1％ and 84.7％.Conclusion ANP,ET-1,vWF may play an important role in the mechanism of the treatment of PPHN by sildenafil,and could be used as an objective index to evaluate the effect of sildenafil on PPHN.