先心病合并肺动脉高压患儿血清H-FABP变化及其临床意义分析

发布时间：2018-05-05 21:08

  本文选题：先天性心脏病 + 肺动脉高压　； 参考：《山西医科大学》2014年硕士论文

【摘要】：目的: 研究先天性心脏病（CHD）合并肺动脉高压（PH）患儿血清心肌型脂肪酸结合蛋白（H-FABP）的变化及其与肺动脉收缩压（PASP）的相关性，探讨H-FABP对于诊断CHD合并PH的临床意义。 方法: 1、CHD确诊及PASP测定，患儿应用频谱多普勒超声心动图检查，确诊CHD并明确其类型，并测出三尖瓣返流的最高流速，依据简化的Bernoulli方程（即ΔP=4V2，V表示最大返流速度）求出右心室与右心房之间的压力差。右室流出道若无梗阻，，PASP则与右心室收缩压（RVSP）相似，即：PASP=RVSP=右房压力（RAP）+三尖瓣跨瓣压力差（ΔP）。其中右房的压力值估计为10mmHg（1mmHg=0.133kPa），即PASP=4V2+10。PH判断标准：SPAP30mmHg为肺动脉压正常，30mmHg SPAP50mmHg为轻度肺动脉高压；50mmHg SPAP70mmHg为中度肺动脉高压；70mmHg为重度肺动脉高压。 2、H-FABP的测定，所有受检者均于清晨空腹抽取静脉血2mL，注入含促凝剂的采血管中，静置2h后以3000r/min离心10min，分离血清放入EP管，分别标记，并放于-70℃的冰箱中保存。待标本收齐后统一采用双抗体夹心(ABC-ELISA）检测H-FABP，ABC-ELISA试剂盒由上海西塘生物科技有限公司提供，操作严格按照试剂说明。 3、统计学方法，所有指标均进行正态性检验，采用SPSS16.0统计软件进行数据处理，采用均数±标准差（x s）进行定量资料描述，采用单因素方差分析进行组间均数比较，两两比较采用LSD-t检验，检验水准α=0.05。相关分析用Pearson相关。P 0.05为差异有统计学意义。 结果: 1、各组血清H-FABP检测结果，正常组、先心无肺高压组、先心伴轻度肺高压组、先心伴中度肺高压组、先心伴重度肺高压组血清H-FABP分别为（1.24±1.06、2.46±1.17、4.19±1.52、11.55±1.83、14.41±1.64）μg/L，5组间比较差异有统计学意义(F=267.981，p0.05)，两两比较发现，CHD各组患儿H-FABP较正常对照组水平升高（P 0.05）；CHD合并不同程度PH组患儿血清H-FABP高于CHD无PH组（P 0.05）；CHD合并不同程度PH中，血清H-FABP含量轻度PH组最低，重度PH组最高（P 0.05）。 2、CHD患儿血清H-FABP与肺动脉压力相关性，66例CHD患儿血清H-FABP与PASP呈正相关（γ=0.952，P 0.05），CHD并PH轻、中、重各组患儿血清H-FABP与PASP呈正相关，即CHD患儿随肺动脉压力的升高，血清H-FABP的含量不断升高。 结论: CHD患儿早期虽未形成肺动脉高压，但已存在一定心肌损害，血清H-FABP升高。当合并PH时，心肌损害明显加重，血清H-FABP明显升高，且随肺动脉压力程度的加重而升高，对于CHD合并PH患儿病情评估有一定指导意义。
[Abstract]:Objective: To study the changes of serum myocardial fatty acid binding protein (H-FABP) in children with congenital heart disease (CHD) and pulmonary hypertension (PH) and its correlation with pulmonary artery systolic pressure (PASP), and to explore the clinical significance of H-FABP in the diagnosis of CHD with PH. Methods: 1the diagnosis of CHD and the determination of PASP. The CHD was diagnosed and its type was determined by spectrum Doppler echocardiography, and the maximum velocity of tricuspid regurgitation was measured. The pressure difference between the right ventricle and the right atrium was calculated by the simplified Bernoulli equation (that is, 螖 Pe 4V 2V denotes the maximum reflux velocity). If right ventricular outflow tract is not obstructed, it is similar to right ventricular systolic blood pressure (RVSP), that is, the tricuspid valve pressure difference (螖 P) of the right ventricular outflow tract (RVSP = right atrial pressure trap) is similar to that of right ventricular systolic pressure (RVSP). The pressure of the right atrium was estimated to be 10 mm Hg1 mm Hgn 0.133 KPA, that is, the normal pulmonary artery pressure was 30 mm Hg and the normal pulmonary artery pressure was 30 mm Hg in the PASP=4V2 10.PH judgment standard. The normal pulmonary artery pressure was 30 mm Hg in the right atrium and the mild pulmonary hypertension was 50 mmHg SPAP70mmHg was the moderate pulmonary hypertension and 70 mmHg was the severe pulmonary hypertension. 2the determination of H-FABP showed that the venous blood samples were taken from all the subjects in the morning, and then injected into the blood vessels containing coagulant. The blood serum was centrifuged with 3000r/min for 10 min, then the serum was labeled and stored in the refrigerator at -70 鈩

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