口服卡托普利预防室间隔缺损并发肺动脉高压临床疗效研究

发布时间：2018-03-24 13:45

本文选题：卡托普利　切入点：室间隔缺损　出处：《中国实用儿科杂志》2017年08期

【摘要】：目的探讨常规剂量卡托普利口服预防室间隔缺损(VSD)继发肺动脉高压的效果和作用机制。方法将成都市妇女儿童中心医院2013年7月至2015年7月收治的符合纳入标准的40例VSD患儿随机均分成空白对照组和卡托普利干预组,于0、1、4、8、12周心脏超声测量肺动脉收缩压(PASP)、肺循环血流量/体循环血流量(Qp/Qs)、右室Tei指数,ELISA方法检测血浆基质金属蛋白酶9(MMP-9)、金属蛋白酶组织抑制因子1(TIMP-1)水平,并观察药物副反应。结果 PASP、Qp/Qs、右室Tei指数、血浆MMP-9、TIMP-1水平在空白组随时间逐渐升高,而干预组随时间逐渐降低,变化趋势组间差异有统计学意义(均P0.05)。所有指标在0周时比较差异无统计学意义(均P0.05);1、4、8、12周4个时间点干预组PASP、右室Tei指数低于空白组(均P0.05);4、8、12周3个时间点干预组Qp/Qs、血浆MMP-9、TIMP-1水平低于空白组(均P0.05)。干预组患儿无一例发生药物副反应。结论对择期手术VSD患儿口服常规剂量卡托普利可改善PASP、右室Tei指数、Qp/Qs指标,可能机制之一是通过降低血浆MMP-9、TIMP-1水平,减轻肺血管重构,预防肺动脉高压,以达到最佳手术年龄。
[Abstract]:Objective to investigate the effect and mechanism of routine dose captopril in the prevention of pulmonary hypertension secondary to ventricular septal defect (VSD). Methods the admitted patients of Chengdu Central Hospital for Women and Children from July 2013 to July 2015 were included in the criteria. All 40 cases of VSD were randomly divided into blank control group and captopril intervention group. Pulmonary artery systolic blood pressure (PASP), pulmonary circulatory blood flow / body circulation blood flow (QP / QS), plasma matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase (TIMP-1) were measured by echocardiography at 12 weeks after 12 weeks. The plasma levels of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) were measured by Tei index Elisa. Results the QP / Qs, the Tei index of right ventricle and the level of MMP-9 / TIMP-1 in plasma increased with time in blank group, but decreased with time in intervention group. There was no significant difference in all indexes at 0 weeks (all P 0.05). The right ventricular Tei index was lower in the intervention group than in the control group at 12 weeks after 12 weeks (all P 0.05) and the right ventricular Tei index was lower than that in the control group (all P 0.05) and the right ventricular Tei index was lower than that in the control group at 12 and 3 weeks (all P0.05) and the right ventricular Tei index was significantly lower than that in the control group (P < 0.05). QP / QS, plasma MMP-9 / TIMP-1 levels were lower than those in the blank group (all P 0.05). No side effects were found in the intervention group. Conclusion Oral routine dose captopril can improve PASP, right ventricular Tei index and QP / Qs index in VSD patients undergoing elective surgery. One of the possible mechanisms is to reduce the level of MMP-9 and TIMP-1, reduce pulmonary vascular remodeling, prevent pulmonary hypertension, and reach the optimal surgical age.
【作者单位】：成都市妇女儿童中心医院儿童心脏科;
【基金】：四川省卫生厅科研课题(080064)
【分类号】：R725.4

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