Lu Huiling, Chen Shaojiun, Wang Hongwei, Cheng Peixuan
Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030.
J Huazhong Univ Sci Technolog Med Sci. 2003;23(3):275-7. doi: 10.1007/BF02829512.
The changes of adrenomedullin (ADM), endothelin-1 (ET-1) and nitric oxide (NO) levels before and after operation in congenital heart disease (CHD) associated with pulmonary hypertension (PH) were observed in order to investigate their role in CHD with PH and their clinical significance. The CHD patients were divided into 3 groups according to pulmonary artery systolic pressure (PASP): Non-PH group: PASP < or = 30 mmHg (n = 11); mild-PH group: PASP 31-49 mmHg (n = 10); moderate or severe-PH group: PASP > or = 50 mmHg (n = 12). The control group consisted of 15 health children. Plasma ADM, ET-1 and NO levels were determined by radioimmunoassay and colorimetry methods. The correlation between ADM and ET-1, NO, PASP was analyzed. The changes in plasma ADM, ET-1 and plasma NO on the 7th day after operation among the groups were compared. The results showed that plasma ADM levels in non-PH group were significantly higher than that in control group (P < 0.05), but there was no significant difference in ET-1 and NO levels between the two groups (P > 0.05). ADM and ET-1 levels in mild-PH group were significantly elevated as compared with those in non-PH group (both P < 0.05), but NO levels were decreased (P < 0.05). ADM and ET-1 levels in moderate or severe-PH groups were increased as compared with those in mild-PH group (both P < 0.01), but NO level significantly declined (P < 0.05). On the 7th day after operation, plasma ADM and ET-1 levels in PH group were significantly decreased (P < 0.05, P < 0.01) as compared with those before operation, but there was no significant difference in NO levels (P > 0.05). But NO levels in non-PH group were significantly increased (P < 0.05). Plasma ADM levels in CHD were positively correlated with PASP and ET-1 (r = 0.77, P < 0.01; r = 0.82, P < 0.01), negatively correlated with NO (r = -0.56, P < 0.05). It was concluded that during the progression of PH in the cases of CHD, plasma ADM, ET-1 and NO might play an important role in the development of PH. The increased ADM may represent a compensatory mechanism. It can interact with NO and ET-1 to regulate pulmonary circulation in the pathophysiology of PH with CHD. ADM may be involved in the defence mechanism against further increase of pulmonary arterial pressure. ADM could be used as a reliable indicator of the severity of CHD associated PH.
观察先天性心脏病（CHD）合并肺动脉高压（PH）患者手术前后肾上腺髓质素（ADM）、内皮素-1（ET-1）和一氧化氮（NO）水平的变化，以探讨它们在CHD合并PH中的作用及其临床意义。根据肺动脉收缩压（PASP）将CHD患者分为3组：非PH组：PASP≤30 mmHg（n = 11）；轻度PH组：PASP 31 - 49 mmHg（n = 10）；中度或重度PH组：PASP≥50 mmHg（n = 12）。对照组由15名健康儿童组成。采用放射免疫法和比色法测定血浆ADM、ET-1和NO水平。分析ADM与ET-1、NO、PASP之间的相关性。比较各组术后第7天血浆ADM、ET-1和血浆NO的变化。结果显示，非PH组血浆ADM水平显著高于对照组（P < 0.05），但两组ET-1和NO水平差异无统计学意义（P > 0.05）。轻度PH组ADM和ET-1水平与非PH组相比显著升高（均P < 0.05），但NO水平降低（P < 0.05）。中度或重度PH组ADM和ET-1水平与轻度PH组相比升高（均P < 0.01），但NO水平显著下降（P < 0.05）。术后第7天，PH组血浆ADM和ET-1水平与术前相比显著降低（P < 0.05，P < 0.01），但NO水平差异无统计学意义（P > 0.05）。而非PH组NO水平显著升高（P < 0.05）。CHD患者血浆ADM水平与PASP和ET-1呈正相关（r = 0.77，P < 0.01；r = 0.82，P < 0.01），与NO呈负相关（r = -0.56，P < 0.05）。结论：在CHD患者PH进展过程中，血浆ADM、ET-1和NO可能在PH的发生发展中起重要作用。ADM升高可能代表一种代偿机制。在CHD合并PH的病理生理过程中，它可与NO和ET-1相互作用调节肺循环。ADM可能参与了防止肺动脉压力进一步升高的防御机制。ADM可作为CHD合并PH严重程度的可靠指标。
