不对称二甲基精氨酸在先天性心脏病相关性肺动脉高压中的临床价值

发布时间：2018-03-29 10:01

本文选题：不对称二甲基精氨酸　切入点：先天性心脏病　出处：《中南大学学报(医学版)》2017年01期

【摘要】：目的:研究血浆不对称二甲基精氨酸(asymmetrical dimethyl-L-arginine,ADMA)作为先天性心脏病(congenital heart disease,CHD)相关肺动脉高压(pulmonary arterial hypertension,PAH)患者诊断、分层与随访指标的应用价值。方法:收集湘雅二医院心血管内科2013年10月至2014年10月经超声心动图证实的CHD患者(n=100),将其分为3组:无PAH组、轻中度PAH组、重度PAH组;重度PAH组又分为动力型亚组、艾森曼格综合征前期亚组、艾森曼格综合征亚组;同时收集健康成人作为对照组(n=25);对20例阻力型患者使用西地那非治疗后随访6个月。采集入选病例所有临床一般情况、心脏彩色超声检查和心导管检查结果,检测血浆ADMA浓度。结果:轻中度PAH组血浆ADMA水平显著高于无PAH组及对照组(均P0.001);重度PAH组血浆ADMA水平显著高于无PAH组及对照组(均P0.001);无PAH组血浆ADMA水平与对照组无统计学差异(P=0.209);在重度PAH组中,艾森曼格综合征亚组患者血浆ADMA水平显著高于动力型亚组(P0.001);ADMA水平与平均肺动脉压(m PAP),全肺阻力(PVR)呈显著正相关(r分别为0.61,0.417,P0.001);血浆ADMA浓度0.485μmol/L时诊断CHD合并重度PAH敏感度为92.0%,特异性为82.7%(P0.001);20例阻力型PAH患者使用西地那非治疗6个月后,肺动脉压力得到改善(P=0.001),血浆ADMA水平显著降低(P0.01)。结论:血浆ADMA水平可作为早期识别CHD-PAH的无创性筛查指标,在一定程度上反映西地那非治疗效果,有望成为CHDPAH患者重要的随访指标。
[Abstract]:Objective: to study the diagnosis of plasma asymmetric dimethyl-L-arginine (ADMA) in patients with pulmonary arterial hypertensionsassociated with congenital heart disease (CHD). Methods: collected CHD patients confirmed by echocardiography from October 2013 to October 2014, and divided them into three groups: no PAH group, mild to moderate PAH group, severe PAH group; The patients with severe PAH were subdivided into three subgroups: dynamic subgroup, Eisenmann syndrome prophase subgroup and Eisenmann syndrome subgroup. At the same time, healthy adults were collected as the control group, and 20 patients with resistive type were followed up for 6 months after treatment with sildenafil. All the general clinical conditions, the results of color echocardiography and cardiac catheterization were collected. Results: the plasma ADMA level in mild to moderate PAH group was significantly higher than that in PAH free group and control group (all P 0.001), the plasma ADMA level in severe PAH group was significantly higher than that in PAH group and control group (all P 0.001), the ADMA level in PAH group and control group was significantly higher than that in control group (P < 0.05). There was no statistical difference (P < 0. 209). In severe PAH group, The plasma ADMA level in Eisenmann syndrome subgroup was significantly higher than that in the dynamic subgroup (P 0.001) and the mean pulmonary arterial pressure was significantly correlated with the mean pulmonary artery pressure. The positive correlation between the plasma ADMA level and the mean pulmonary arterial pressure was 0.61 卤0.417 渭 mol/L, respectively, and that in the diagnosis of CHD with severe PAH sensitivity at 0.485 渭 mol/L of plasma ADMA concentration was significantly higher than that in the dynamic subgroup. After 6 months of treatment with sildenafil, 20 patients with resistive PAH had a specificity of 82.7% and a specificity of 82.7%. Pulmonary artery pressure was improved and plasma ADMA level was significantly decreased. Conclusion: plasma ADMA level can be used as a noninvasive screening index for early identification of CHD-PAH, reflecting the efficacy of sildenafil treatment to a certain extent, and it is expected to be an important follow-up index for CHDPAH patients.
【作者单位】：中南大学湘雅二医院心内科;
【分类号】：R541.1;R544.1

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