CAJ | 학술논문

目的观察先天性心脏病动脉导管未闭(PDA)患儿介入封堵术后联合应用前列地尔注射液对术后血浆氨基末端脑利钠肽前体(NT-proBNP)水平及心室重构的影响.方法选择河北医科大学第一医院2011年1月至2013年1月住院行介入封堵治疗的PDA患儿120例,男53例,女67例,年龄5～8岁[(6.2±2.1)岁].应用随机数字表法随机分为前列地尔组60例及对照组60例,分别在术前、术后第3天、术后6个月采用双向侧流免疫法测定其血浆NT-proBNP水平,所有患儿在术前、术后第7天和术后6个月分别进行超声心动图检查,测定左心室舒张末前后径(LVEDD)、左心室收缩末前后径(LVESD)、左心室收缩末容量(LVESV)、左心室舒张末容量(LVEDV)、左心室射血分数(LVEF).比较2组临床特征、血浆NT-proBNP水平及心室重构参数变化.结果 2组患儿LVEDD、LVESD、LVEDV、LVESV在介入术后第7天及术后6个月均明显小于术前(P均＜0.05),且封堵术后6个月前列地尔组较对照组减小更明显(P＜0.05).2组患儿术前血浆NT-proBNP水平差异无统计学意义(P＞0.05);2组患儿血浆NT-proBNP水平术后第3天与术后6个月比较差异均有统计学意义(P均＜0.01),且前列地尔组封堵术后6个月较对照组下降更明显(P＜0.01).结论 PDA患儿介入封堵术基础上联合前列地尔治疗可进一步降低血浆NT-proBNP水平,并改善患儿的心室重构.
목적 관찰선천성심장병동맥도관미폐(PDA)환인개입봉도술후연합응용전렬지이주사액대술후혈장안기말단뇌리납태전체(NT-proBNP)수평급심실중구적영향.방법 선택하북의과대학제일의원2011년1월지2013년1월주원행개입봉도치료적PDA환인120례,남53례,녀67례,년령5～8세[(6.2±2.1)세].응용수궤수자표법수궤분위전렬지이조60례급대조조60례,분별재술전、술후제3천、술후6개월채용쌍향측류면역법측정기혈장NT-proBNP수평,소유환인재술전、술후제7천화술후6개월분별진행초성심동도검사,측정좌심실서장말전후경(LVEDD)、좌심실수축말전후경(LVESD)、좌심실수축말용량(LVESV)、좌심실서장말용량(LVEDV)、좌심실사혈분수(LVEF).비교2조림상특정、혈장NT-proBNP수평급심실중구삼수변화.결과 2조환인LVEDD、LVESD、LVEDV、LVESV재개입술후제7천급술후6개월균명현소우술전(P균＜0.05),차봉도술후6개월전렬지이조교대조조감소경명현(P＜0.05).2조환인술전혈장NT-proBNP수평차이무통계학의의(P＞0.05);2조환인혈장NT-proBNP수평술후제3천여술후6개월비교차이균유통계학의의(P균＜0.01),차전렬지이조봉도술후6개월교대조조하강경명현(P＜0.01).결론 PDA환인개입봉도술기출상연합전렬지이치료가진일보강저혈장NT-proBNP수평,병개선환인적심실중구.
Objective To observe the changes of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and ventricular remodeling in children with patent ductus arteriosus(PDA) after interventional therapy combined with Alprostadil injection.Methods A total of 120 patients [53 male,67 female,aged (6.2 ± 2.1) years] with PDA for cardiac catheter occlusion in the First Hospital of Hebei Medical University from Jan.2011 to Jan.2013 were enrolled in this study.All the patients were randomized to the Alprostadil group (n =60) and the control group (n =60).Concentrations of plasma NT-proBNP were measured by using Bi-directional lateral flow immunoassay before and the third day and sixth month after cardiac catheterization,respectively.Before and the seventh day and sixth month after cardiac catheterization,the parameters of left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter (LVESD),left ventricular end systolic volume (LVESV),left ventricular end diastolic volume (LVEDV) and left ventricular ejection fraction(LVEF) were measured by echocardiography.The clinical characteristics,level of plasma NT-proBNP and the change of ventricular remodeling parameters were compared between the two groups.Results The parameters of LVEDD,LVESD,LVESV and LVEDV on the third day and sixth months after catheterization were decreased significantly as compared to those before catheterization between 2 groups (all P ＜0.05),while those in the Alprostadil group were more as compared with the control group in the six months after catheterization(P ＜ 0.05).There was no difference in plasma NT-proBNP levels measured between control group and Alprostadil group before catheterization(P ＞ 0.05).In the sixth month after catheterization,the plasma NT-proBNP level decreased significantly as compared to that on the third day after catheterization in 2 groups (P ＜ 0.01),while in the Alprostadil group it was more decreased as compared with the control group (all P ＜ 0.01).Conclusions Alprostadil injection combined interventional therapy can further reduce the level of plasma NT-proBNP and improve ventricular remodeling in the children with PDA.