儿童先天性心脏病介入治疗及心肌损伤探究.docVIP

儿童先天性心脏病介入治疗及心肌损伤探究 　 作者：邓军，孔祥清，朱永锋，杨荣，盛燕辉，曹克将 【摘要】 目的 探讨儿童先天性心脏病(CHD)患者血清中可溶性细胞粘附分子-1(sICAM-1)、可溶性P选择素(sPs)、心肌钙蛋白I(cTnI) 在介入治疗前后的变化及其意义。方法 用酶联免疫吸附法(ELISA)检测30例CHD患者血清中sICAM-1、sPs、cTnI在介入封堵治疗术前后的浓度并进行比较。结果 与术前相比，术后即刻sICAM-1、sPs、cTnI升高，术后24、48h下降，其中48h达最低水平，但差异无显著性(P均gt;0.05)，sICAM-1、cTnI术后72 h显著升高(P均lt;0.01)，但所有cTnI值均在正常范围。结论 介入治疗儿童CHD可以激活sICAM-1、sPs的表达，并可以造成心肌组织的微小损伤。 【关键词】 儿童；先天性心脏病; 介入治疗; 细胞间粘附分子-1; P-选择素; 心肌钙蛋白I Abstract: Objective To analyze the changes and the significances of serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble P-selection (sPs) and cardiac tropin I (cTnI) after transcatheter closure in children with congenital heart disease (CHD). Methods An enzyme linked immunosorbent assay (ELISA) was used to measure serum concentrations of sICAM-1, sPs and cTnI in 30 chldren with CHD before and after transcatheter closure. Results The levels of sICAM-1, sPs, cTnI elevated significantly immediate after transcatheter closure, at the end of closing procedure (compared to pre-procedure), decreased at 24 hour, 48 hour after procedure, decreased to the baseline at 48 hour after procedure, but there was no statistically significant difference between them (Pgt;0.05); sICAM-1, cTnI increased significantly at 72 hour after procedure (compared to pre-procedure, Plt;0.01). All the serum levels of cTnI were in normal range. Conclusion Transcatheter closure for children with CHD may activate the expression of sICAM-1 and sPs. The rise of serum levels of cTnI is in normal range suggested that minor myocardial injury occur during the procedure. 　　Key words: children; congenital heart disease; transcatheter therapy; intercellular adhesion molecule-1; P-selectin; cardiac troponin I 介入治疗儿童先天性心脏病(congenital heart disease， CHD)时，由于操作器械可直接损伤内皮和心肌，同时由于植入的封堵器和操作过程中使用的器械均是异物，血液与人工材料表面接触可引起多种血液因子的变化，进而介导炎症和损伤［1～3］。本研究检测介入治疗儿童CHD前后患者血清中可溶性细胞粘附分子-1(soluble intercellular adhesion molecule-1，sICAM-1)、可溶性P选择素(soluble P-selectin，sP-selectin，sPs)、心肌钙蛋白I(cardiac trop