發(fā)布時間：2018-03-29 10:01

  本文選題：不對稱二甲基精氨酸　切入點：先天性心臟病　出處：《中南大學學報(醫(yī)學版)》2017年01期

【摘要】：目的:研究血漿不對稱二甲基精氨酸(asymmetrical dimethyl-L-arginine,ADMA)作為先天性心臟病(congenital heart disease,CHD)相關肺動脈高壓(pulmonary arterial hypertension,PAH)患者診斷、分層與隨訪指標的應用價值。方法:收集湘雅二醫(yī)院心血管內(nèi)科2013年10月至2014年10月經(jīng)超聲心動圖證實的CHD患者(n=100),將其分為3組:無PAH組、輕中度PAH組、重度PAH組;重度PAH組又分為動力型亞組、艾森曼格綜合征前期亞組、艾森曼格綜合征亞組;同時收集健康成人作為對照組(n=25);對20例阻力型患者使用西地那非治療后隨訪6個月。采集入選病例所有臨床一般情況、心臟彩色超聲檢查和心導管檢查結果,檢測血漿ADMA濃度。結果:輕中度PAH組血漿ADMA水平顯著高于無PAH組及對照組(均P0.001);重度PAH組血漿ADMA水平顯著高于無PAH組及對照組(均P0.001);無PAH組血漿ADMA水平與對照組無統(tǒng)計學差異(P=0.209);在重度PAH組中,艾森曼格綜合征亞組患者血漿ADMA水平顯著高于動力型亞組(P0.001);ADMA水平與平均肺動脈壓(m PAP),全肺阻力(PVR)呈顯著正相關(r分別為0.61,0.417,P0.001);血漿ADMA濃度0.485μmol/L時診斷CHD合并重度PAH敏感度為92.0%,特異性為82.7%(P0.001);20例阻力型PAH患者使用西地那非治療6個月后,肺動脈壓力得到改善(P=0.001),血漿ADMA水平顯著降低(P0.01)。結論:血漿ADMA水平可作為早期識別CHD-PAH的無創(chuàng)性篩查指標,在一定程度上反映西地那非治療效果,有望成為CHDPAH患者重要的隨訪指標。
[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 鹵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.
【作者單位】： 中南大學湘雅二醫(yī)院心內(nèi)科;
【分類號】：R541.1;R544.1

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