Department of Pediatrics, University Hospital of Tampere, Tampere, Finland.
Eur J Cardiothorac Surg. 2010 Dec;38(6):735-40. doi: 10.1016/j.ejcts.2010.03.056. Epub 2010 May 18.
In children treated for univentricular heart (UVH), prospective evaluation of serum levels of N-terminal proatriopeptide (ANPN) and N-terminal pro-brain natriuretic peptide (NT-proBNP) was performed.
Serum samples were analysed in 19 children before the first operation, before the bi-directional Glenn (BDG) operation, at age 1 year and before total cavopulmonary connection (TCPC). In addition, we performed cross-sectional measurement of peptide levels in 32 children: 22 hypoplastic left ventricle (LV), 10 hypoplastic right ventricle (RV) before; and in 12 children: nine hypoplastic LV, three hypoplastic RV, 2 (range: 0.5-5.3) years after the TCPC operation. Controls comprised 12 children aged less than 6 months and 41 children aged from 6 months to 7 years.
Between the first and second operations, peptide levels decreased. Before TCPC, further decreases had occurred. Throughout follow-up, peptide levels were higher than in controls. In the cross-sectional study, before TCPC, median ANPN concentration measured 0.37 (range: 0.18-1.00) nmol l(-1) (P=0.059, compared with controls) and NT-proBNP 155 (range: 13-718) ng l(-1) (P<0.001). After TCPC, median ANPN concentration measured 0.39 (range: 0.09-0.98) nmol l(-1) (P=ns) and NT-proBNP 201 (range: 76-1406) ng l(-1) (P<0.001). Before TCPC, levels of NT-proBNP were higher in patients with RV than with LV morphology.
Natriuretic peptide levels decreased during treatment protocol for UVH, but NT-proBNP levels remained higher than in controls. These reflect reduction of volume overload of the single ventricle and can prove useful for haemodynamic monitoring.
在接受单心室心脏（UVH）治疗的儿童中，前瞻性评估血清 N 末端脑钠肽前体（ANPN）和 N 末端 pro-brain 利钠肽（NT-proBNP）水平。
19 例患儿在第一次手术前、双向 Glenn（BDG）手术前、1 岁时和全腔静脉肺动脉连接（TCPC）前采集血清样本进行分析。此外，我们对 32 例患儿进行了肽水平的横断面测量：22 例左心室发育不全（LV）、10 例右心室发育不全（RV），以及 12 例：9 例左心室发育不全、3 例右心室发育不全、2（范围：0.5-5.3）年后 TCPC 手术后。对照组包括 12 名年龄小于 6 个月的儿童和 41 名年龄从 6 个月到 7 岁的儿童。
在第一次和第二次手术之间，肽水平下降。在 TCPC 之前，又出现了下降。在整个随访期间，肽水平均高于对照组。在横断面研究中，在 TCPC 之前，中位 ANPN 浓度为 0.37（范围：0.18-1.00）nmol l(-1)（P=0.059，与对照组相比），NT-proBNP 浓度为 155（范围：13-718）ng l(-1)（P<0.001）。在 TCPC 后，中位 ANPN 浓度为 0.39（范围：0.09-0.98）nmol l(-1)（P=ns），NT-proBNP 浓度为 201（范围：76-1406）ng l(-1)（P<0.001）。在 TCPC 之前，RV 形态的患者 NT-proBNP 水平高于 LV 形态的患者。
在治疗单心室心脏的方案中，利钠肽水平下降，但 NT-proBNP 水平仍高于对照组。这反映了单心室容量超负荷的减少，可用于血流动力学监测。
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