血清嗜铬粒蛋白A、尾加压素Ⅱ在小儿慢性心力衰竭中的变化及意义
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摘要
目的观察血清嗜铬粒蛋白A(Cg A)和尾加压素Ⅱ(UⅡ)在小儿慢性心力衰竭中的变化及意义。方法采用回顾性研究方法将2015年5月至2016年5月收治的46例小儿慢性心力衰竭患者作为观察组,同时选取同一时期进行常规体检的32例健康儿童作为对照组,对比分析两组研究对象血清嗜铬粒蛋白A、尾加压素Ⅱ检测水平,探讨Cg A、UⅡ水平与心功能分级及心室重构参数的关系。结果慢性心力衰竭患儿Cg A水平较正常对照组明显升高(P<0.05),UⅡ水平则较对照组明显下降(P<0.05),且随着病变程度的加重,而随之升高或降低(P<0.05)。扩张型心肌病组与心内膜弹力纤维增生组Cg A、UⅡ水平比较差异无统计学意义(P>0.05),血清Cg A水平与左心室质量分数(LVMI)以及心功能分级呈正相关关系(P<0.05),与左室短轴缩短率(LVFS)和左室射血分数(LVEF)以及UⅡ呈负相关关系(P<0.05),血清UⅡ则与心功能分级呈现负相关关系(P<0.05),与LVMI、LVEF、LVFS相关关联不大(P>0.05)。结论 Cg A在心室重构过程中发挥作用,检测Cg A和UⅡ水平变化可为判断慢性心力衰竭病变程度提供参考。
Ojective To observe the significance and changes in serum chromaffin granule protein A( Cg A) and tail vasopressinⅡ( UⅡ) in pediatric patients with chronic heart failure. Methods A retrospective study method was carried out in May 2015 to May 2016 in this hospital for treatment,and the clinical data of 46 pediatric patients with chronic heart failure were retrospectively analyzed. These patients were listed in observation group,and 32 healthy children in the same period in this hospital for regular physical examination were listed as control group. The serum levels of chromaffin granule protein A,tail vasopressin II,Cg A,and UⅡwere compared between pediatric patients with chronic heart failure and healthy controls. Results The level of Cg A in pediatric patients with chronic heart failure was obviously higher than that of normal control group( P < 0.05),while level of UⅡ was significantly decreased than that of control group( P < 0. 05),and the degree of pathological changes was aggravated,then raise or lower( P < 0. 05). The difference in DCM group in elastic fibrous hyperplasia of endocardium and levels of Cg A and UII compared between DCM group and endocardial elastic proliferation group has no statistical significance( P > 0. 05),serum level of Cg A and left ventricular mass fraction( LVMI) and cardiac function( P < 0. 05),the relationship was positively correlated with left ventricular short axis shortening rate( LVFS)and left ventricular ejection fraction( LVEF),and negatively related with level of UⅡ( P < 0. 05),serum UⅡwith cardiac function grading showed negative correlation( P < 0. 05),and related association with LVMI,LVEF,LVFS( P > 0. 05). Conclusion The serum Cg A plays a role in the process of ventricular remodeling,and changes in levels of Cg A and UⅡ can provide diagnostic reference for the severity of chronic heart failure.
Ojective To observe the significance and changes in serum chromaffin granule protein A( Cg A) and tail vasopressinⅡ( UⅡ) in pediatric patients with chronic heart failure. Methods A retrospective study method was carried out in May 2015 to May 2016 in this hospital for treatment,and the clinical data of 46 pediatric patients with chronic heart failure were retrospectively analyzed. These patients were listed in observation group,and 32 healthy children in the same period in this hospital for regular physical examination were listed as control group. The serum levels of chromaffin granule protein A,tail vasopressin II,Cg A,and UⅡwere compared between pediatric patients with chronic heart failure and healthy controls. Results The level of Cg A in pediatric patients with chronic heart failure was obviously higher than that of normal control group( P < 0.05),while level of UⅡ was significantly decreased than that of control group( P < 0. 05),and the degree of pathological changes was aggravated,then raise or lower( P < 0. 05). The difference in DCM group in elastic fibrous hyperplasia of endocardium and levels of Cg A and UII compared between DCM group and endocardial elastic proliferation group has no statistical significance( P > 0. 05),serum level of Cg A and left ventricular mass fraction( LVMI) and cardiac function( P < 0. 05),the relationship was positively correlated with left ventricular short axis shortening rate( LVFS)and left ventricular ejection fraction( LVEF),and negatively related with level of UⅡ( P < 0. 05),serum UⅡwith cardiac function grading showed negative correlation( P < 0. 05),and related association with LVMI,LVEF,LVFS( P > 0. 05). Conclusion The serum Cg A plays a role in the process of ventricular remodeling,and changes in levels of Cg A and UⅡ can provide diagnostic reference for the severity of chronic heart failure.
引文
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[10]甄宇治,邓彦东,段立楠,等.比索洛尔对左室射血分数保留的心力衰竭患者嗜铬粒蛋白A及心功能的影响[J].中国循证心血管医学杂志,2016,8(8):919-921.
[11]范建华.嗜铬粒蛋白A在慢性心力衰竭患者中的表达及其对预后的影响[D].苏州:苏州大学,2015.
[12]杨冬花,罗建华,袁志柳,等.心力衰竭大鼠不同时期尾加压素Ⅱ、内皮素-1和肾上腺髓质素水平变化及益气温阳活血方对其影响的研究[J].贵州医药,2012,36(1):4-7.
[13]张一梅.慢性栓塞性肺动脉高压大鼠肺动脉重构与尾加压素Ⅱ和s GC的分子生物学研究[D].哈尔滨:哈尔滨医科大学,2007.
[14]富路,戴颖楠,朱立群,等.慢性心功能衰竭患者血浆尾加压素Ⅱ、内皮素和肾上腺髓质素的变化[J].中国动脉硬化杂志,2007,15(3):201-204.
[15]孙小刚,胡节惠.尾加压素Ⅱ在心衰发生发展中的变化及研究进展[J].泸州医学院学报,2010,33(1):97-99.
[2]张居卫,姜燕飞,张海英.非黄嘌呤类腺苷阻断剂对慢性心衰心室重构及肾素-血管紧张素-醛固酮系统的影响[J].中国基层医药,2015,20(16):2457-2460.
[3]贺兆发,高占群,金梅花,等.慢性心衰患者血浆尾加压素Ⅱ与嗜铬粒蛋白A的相关性[J].心血管康复医学杂志,2011,20(2):123-125.
[4]中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会.小儿心力衰竭诊断与治疗建议[J].中华儿科杂志,2006,44(10):753-757.
[5]陈健.心脏常见疾病超声诊断分册[M].太原:山西科学技术出版社,2014:251-259.
[6]张宁.卡托普利治疗小儿慢性心力衰竭的临床疗效及安全性分析[J].河南医学研究,2015,24(12):87-87.
[7]钱永如.小儿慢性心力衰竭治疗进展[J].中华实用儿科临床杂志,2006,21(18):1202-1204.
[8]李葆华,刘凌,肖纯,等.左卡尼汀口服液对慢性心力衰竭患者血清NT-pro BNP、TNF-α、IL-6、MMP-9和心功能的影响[J].临床和实验医学杂志,2016,15(8):765-768.
[9]杨秀丽,刘迎春,冉倩,等.辛伐他汀对慢性心力衰竭幼兔心肌嗜铬粒蛋白A、细胞凋亡信号调节激酶1表达的影响[J].中华实用儿科临床杂志,2017,32(5):365-368.
[10]甄宇治,邓彦东,段立楠,等.比索洛尔对左室射血分数保留的心力衰竭患者嗜铬粒蛋白A及心功能的影响[J].中国循证心血管医学杂志,2016,8(8):919-921.
[11]范建华.嗜铬粒蛋白A在慢性心力衰竭患者中的表达及其对预后的影响[D].苏州:苏州大学,2015.
[12]杨冬花,罗建华,袁志柳,等.心力衰竭大鼠不同时期尾加压素Ⅱ、内皮素-1和肾上腺髓质素水平变化及益气温阳活血方对其影响的研究[J].贵州医药,2012,36(1):4-7.
[13]张一梅.慢性栓塞性肺动脉高压大鼠肺动脉重构与尾加压素Ⅱ和s GC的分子生物学研究[D].哈尔滨:哈尔滨医科大学,2007.
[14]富路,戴颖楠,朱立群,等.慢性心功能衰竭患者血浆尾加压素Ⅱ、内皮素和肾上腺髓质素的变化[J].中国动脉硬化杂志,2007,15(3):201-204.
[15]孙小刚,胡节惠.尾加压素Ⅱ在心衰发生发展中的变化及研究进展[J].泸州医学院学报,2010,33(1):97-99.