CAJ | 학술논문

目的研究先天性心脏病(CHD)的发病机制,探讨结缔组织生长因子(CTGF)在CHD及肺动脉高压(PH)早期诊断中的价值.方法选取山西省儿童医院心内科和心胸外科2012年9月至2013年1月收治的CHD患儿中的66例,据心脏彩色多普勒超声估算肺动脉收缩压,分为单纯CHD组16例,合并轻度PH组18例,合并中度PH组17例,合并重度PH组15例;按类型分为室间隔缺损(VSD) 23例,房间隔缺损(ASD) 17例,动脉导管未闭(PDA)14例,复合型(合并2种以上的先天性心血管异常)12例.随机数字表法抽取同期江西省儿童医院门诊体检的20例健康儿童作为健康对照组.通过双抗体夹心酶链免疫吸附法测定研究对象血清中CTGF水平,按不同肺动脉收缩压和不同类型CHD将各组间血清CTGF水平分别进行比较,分析CHD各组患儿血清CTGF水平与肺动脉收缩压的相关性.结果定量检测表明CHD各组患儿血清中CTGF水平显著高于健康对照组(P＜0.05),CHD合并PH各组患儿血清CTGF水平均高于单纯CHD组(P＜0.05),随着肺动脉压力的升高,CHD患儿血清CTGF水平逐级上升(P＜0.05).相关分析显示CHD各组患儿血清CTGF水平与肺动脉压力呈正相关(r =0.670,P=0.005;r =0.514,P=0.029;r =0.517,P =0.034;r=0.707,P =0.003).不同类型CHD患儿血清CTGF水平比较差异无统计学意义(F=0.270,P=0.847).结论 CHD早期(未合并PH时)已经存在心肌纤维化损害,当合并PH时,心肌纤维化随肺动脉压力的升高逐渐加重,但心肌纤维化程度与CHD的类型无关.
목적 연구선천성심장병(CHD)적발병궤제,탐토결체조직생장인자(CTGF)재CHD급폐동맥고압(PH)조기진단중적개치.방법 선취산서성인동의원심내과화심흉외과2012년9월지2013년1월수치적CHD환인중적66례,거심장채색다보륵초성고산폐동맥수축압,분위단순CHD조16례,합병경도PH조18례,합병중도PH조17례,합병중도PH조15례;안류형분위실간격결손(VSD) 23례,방간격결손(ASD) 17례,동맥도관미폐(PDA)14례,복합형(합병2충이상적선천성심혈관이상)12례.수궤수자표법추취동기강서성인동의원문진체검적20례건강인동작위건강대조조.통과쌍항체협심매련면역흡부법측정연구대상혈청중CTGF수평,안불동폐동맥수축압화불동류형CHD장각조간혈청CTGF수평분별진행비교,분석CHD각조환인혈청CTGF수평여폐동맥수축압적상관성.결과 정량검측표명CHD각조환인혈청중CTGF수평현저고우건강대조조(P＜0.05),CHD합병PH각조환인혈청CTGF수평균고우단순CHD조(P＜0.05),수착폐동맥압력적승고,CHD환인혈청CTGF수평축급상승(P＜0.05).상관분석현시CHD각조환인혈청CTGF수평여폐동맥압력정정상관(r =0.670,P=0.005;r =0.514,P=0.029;r =0.517,P =0.034;r=0.707,P =0.003).불동류형CHD환인혈청CTGF수평비교차이무통계학의의(F=0.270,P=0.847).결론 CHD조기(미합병PH시)이경존재심기섬유화손해,당합병PH시,심기섬유화수폐동맥압력적승고축점가중,단심기섬유화정도여CHD적류형무관.
Objective To further study the pathogenesis for congenital heart disease (CHD) and connective tissue growth factor(CTGF) for the early diagnosis of CHD and pulmonary hypertension (PH).Methods Sixty-six cases of children with CHD were selected from the thoracic surgery who were performed in the Children's Hospital of Shanxi Province during the period between Sep.2012 and Jan.2013.Based on the cardiac color Doppler estimation of the pulmonary artery systolic pressure,they were classified into several groups:unincorporated PH group with 16 cases,mild PH group with 18 cases,moderate PH group with 17 cases,and severe PH group with 15 cases.Based on types,the 66 cases could be classified as ventricular septal defect (VSD) group with 23 cases,atrial septal defect (ASD) group with 17 cases,patent ductus arteriosus(PDA) group with 14 cases,and composite(including 2 or more of the congenital cardiovascular anomalies) group with 12 cases.Twenty healthy children who had medical examination over the same period in the Children's Hospital of Shanxi Province were randomly chosen as the healthy control group.The serum concentration of CTGF in the research objects were determined with the aid of double antibody sandwich enzyme-linked immunosorbent assay method.According to the different pulmonary artery systolic pressure and different types of CHD,the serum concentration of CTGF were compared among groups.The correlation of between the CTGF concentration in the serum and pulmonary artery systolic pressure were also analyzed among the groups of children with CHD.Results Quantitative measurement revealed that the serum CTGF concentration measured in the groups of children with CHD were significantly higher than that in the healthy control group(P ＜ 0.05) ; the serum CTGF concentration of the children with CHD and PH was higher than that in the group of children with CHD alone(P ＜ 0.05).With the increase in pulmonary artery pressure,CHD patients serum levels of CTGF also increased(P ＜ 0.05).By the correlation analysis,the results showed that the serum level of CTGF in the CHD groups were positively correlated with the pulmonary artery pressure (r =0.670,P =0.005 ; r =0.514.P =0.029 ; r =0.517,P =0.034 ; r =0.707,P =0.003).The difference in terms of serum CTGF concentration in different types of CHD patients was not significant (F =0.270,P =0.847).Conclusions There exists certain damage in CHD early myocardial fibrosis(unincorporated PH),when combined with PH,myocardial fibrosis increases with the gradual increase of pulmonary artery pressure.However,the degree of myocardial fibrosis shows no correlation with the type of CHD.