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目的:探讨血浆硫化氢(H2S)、内皮素(ET-1)、降钙素基因相关肽(CGRP)在肺多血型先天性心脏病(先心病,CHD)围手术期的变化及其临床意义。方法:选取健康体检儿20例为对照组(A组),CHD无肺动脉高压(PH)组[B组,肺动脉收缩压(SPAP)<30mmHg]25例,轻度PH组(C组,SPAP 30-49mmHg)25例,中、重度PH组(D组,SPAP≥50mmHg)18例。测量CHD组患儿术前1d、术后2d和对照组儿童血浆H2S、ET-1、CGRP浓度,比较不同组患儿手术前后血浆各因子浓度的变化及与SPAP、PP/PS、QP/QS等之间的关系。结果:血浆H2S浓度在CHD组较对照组、PH组较无PH组、D组较C组均降低,不同程度PH组中血浆H2S的浓度随着SPAP的升高而降低;术后早期不同程度PH组间血浆H2S浓度仍存在差异(P<0.05);血浆H2S与SPAP、PP/PS、QP/QS均呈负相关(︱r︱>0.63)。CHD患儿较对照组血浆ET-1明显升高,而CGRP水平明显降低;随着SPAP的升高,ET-1水平升高得越明显,CGRP下降得越明显;术后早期,血浆ET-1水平降低,血浆CGRP水平升高,但不同程度PH组之间仍存在差异(P<0.05);血浆ET-1与CGRP水平有良好的相关性(r=-0.641);ET-1与SPAP呈正性相关,CGRP与之呈负性相关,ET-1/CGRP比值与SPAP、QP/QS亦呈正性相关(r=0.74、0.536,P<0.05)。结论:H2S/CSE体系、ET-1/CGRP体系在PH的发生发展中具有重要作用,两者相互作用,动态调节平衡。在CHD合并PH早期,及时纠正异常血流动力学后大多恢复良好。
Objective: To investigate the changes and clinical significance of plasma hydrogen sulfide (H2S), endothelin (ET-1) and calcitonin gene related peptide (CGRP) in the perioperative period of pulmonary multiple blood type congenital heart disease (CHD) . Methods: Twenty healthy subjects were selected as the control group (group A), CHD without pulmonary hypertension (group B), pulmonary arterial systolic pressure (SPAP) <30 mmHg, 25 patients with mild PH (group C, SPAP 30 -49mmHg) 25 cases, moderate and severe PH group (D group, SPAP ≥ 50mmHg) in 18 cases. The changes of plasma concentrations of H2S, ET-1 and CGRP in children with CHD at 1 day, 2 days and 2 days after operation were compared before and after operation, and the changes of plasma concentrations of SPAP, PP / PS, QP / QS And so on the relationship between. Results: Plasma H2S concentration was lower in CHD group than in control group, PH group was lower than PH group, D group was lower than C group, plasma H2S concentration was decreased with the increase of SPAP in different PH groups. Plasma H2S concentrations were still significantly different between PH groups (P <0.05). Plasma H2S was negatively correlated with SPAP, PP / PS and QP / QS (︱r︱> 0.63). The level of ET-1 in CHD patients was significantly higher than that in the control group, while the level of CGRP was significantly decreased. With the increase of SPAP, the level of ET-1 increased significantly and the level of CGRP decreased significantly. In the early postoperative period, (P <0.05). There was a significant correlation between plasma ET-1 and CGRP level (r = -0.641). ET-1 and SPAP There was a positive correlation between CGRP and ET-1 / CGRP and SPAP and QP / QS (r = 0.74, 0.536, P <0.05). Conclusion: The H2S / CSE system and ET-1 / CGRP system play an important role in the occurrence and development of PH. The two systems interact with each other and regulate the balance dynamically. In the early phase of CHD combined with PH, most patients recover well after promptly correcting abnormal hemodynamics.