Altın Hakan, Karataş Zehra, Sap Fatih, Alp Hayrullah, Baysal Tamer, Karaaslan Sevim, Oran Bülent
Selçuk Üniversitesi Meram Tıp Fakültesi, Çocuk Kardiyolojisi Bilim Dalı, Konya-Turkey.
Anadolu Kardiyol Derg. 2012 Mar;12(2):150-9. doi: 10.5152/akd.2012.041. Epub 2012 Jan 3.
To evaluate the association between the degree of pulmonary arterial hypertension (PAH) and the level of malnutrition in children with acyanotic congenital heart diseases and left-to-right shunt, and especially to evaluate the development rates of malnutrition in patients with borderline PAH.
The study was performed with data of 327 patients with acyanotic congenital heart diseases and left-to-right shunt and underwent cardiac catheterization between January 2001-February 2011. The design of the study was retrospective and observational. All patients were evaluated with anthropometric measurements, echocardiography and cardiac catheterization. They were classified according to the mean pulmonary artery pressure and level of malnutrition. Chi-square, ANOVA and Kruskal-Wallis tests were used for statistical analysis. Normally and abnormally distributed data were analyzed with Pearson and Spearman correlation tests respectively.
Malnutrition was detected in 94.8% of patients with PAH and 17.2% of no PAH patients according to Gomez classification (p<0.001). In addition, malnutrition was detected in 23.5% (16/68) of borderline PAH group. A negative association was detected between mean pulmonary arterial pressure and body weight for age (Gomez) and z scores of weight (p<0.001 for all). Z scores of weight and height were significantly decreased in patients with PAH in contrast to no PAH group (p<0.001, p<0.01 respectively). There was no statistical difference between no PAH and borderline PAH groups according to Gomez classification and relative body weight formula, however z scores of weight in borderline PAH group were decreased compared with no PAH group (p<0.001).
A positive association was detected between the degrees of PAH and level of malnutrition in children with a cyanotic congenital heart diseases with left-to-right shunt. Borderline PAH may be a predisposing factor for malnutrition and further studies are needed for this subject.
评估无青紫型先天性心脏病且有左向右分流患儿的肺动脉高压（PAH）程度与营养不良水平之间的关联，尤其评估临界PAH患者营养不良的发生率。
本研究采用2001年1月至2011年2月间327例无青紫型先天性心脏病且有左向右分流并接受心导管检查患者的数据。研究设计为回顾性观察性研究。所有患者均接受人体测量、超声心动图和心导管检查。根据平均肺动脉压和营养不良水平进行分类。采用卡方检验、方差分析和Kruskal-Wallis检验进行统计分析。正态分布和非正态分布数据分别采用Pearson和Spearman相关检验进行分析。
根据戈麦斯分类，PAH患者中94.8%存在营养不良，无PAH患者中17.2%存在营养不良（p<0.001）。此外，临界PAH组中23.5%（16/68）存在营养不良。平均肺动脉压与年龄别体重（戈麦斯分类）和体重z评分之间存在负相关（均p<0.001）。与无PAH组相比，PAH患者的体重和身高z评分显著降低（分别为p<0.001，p<0.01）。根据戈麦斯分类和相对体重公式，无PAH组和临界PAH组之间无统计学差异，但临界PAH组的体重z评分低于无PAH组（p<0.001）。
在无青紫型先天性心脏病且有左向右分流的患儿中，PAH程度与营养不良水平之间存在正相关。临界PAH可能是营养不良的一个易感因素，对此主题需要进一步研究。
