小儿先天性心脏病介入治疗后心肌损伤和炎症反应的研究

Myocardial injury and inflammatory response after interventional therapy in children with congenital heart disease

摘要:

目的：研究先天性心脏病（CHD）介入治疗后7 d心肌损伤和炎症反应。方法：选择77例CHD患儿，其中室间隔缺损（VSD）12例，肺动脉瓣狭窄(PS)14例，房间隔缺损（ASD）14例，动脉导管未闭（PDA）37例。检测术后即刻、术毕、术后6 h、24 h、72 h及7 d 的血清心肌酶（AST、CK、CKMB）、肌钙蛋白I(cTnI)和CRP值的变化。结果：VSD组AST水平于术后即刻，术后6 h和术后24 h明显高于其他3种类型CHD组（P<0.05）；术后即刻及术后6 h各组间CK及CKMB水平差异有统计学意义，以VSD组最高；术后72 h和术后7 d PDA组CRP水平明显高于其他3种类型CHD组（P<0.05）。与术前相比，术后6 h和24 h，4种类型CHD组AST均明显升高（P<0.05）；术后即刻和术后6 h，VSD组CK和CKMB水平较术前明显升高（P<0.05）；术后即刻和术后6 h，VSD、PDA和PS组cTnI水平较术前明显升高（P<0.05）；PDA组CRP水平术后24 h、72 h和7 d较术前明显升高（P<0.05）。结论：介入治疗CHD 7 d内可引起轻微心肌损伤，以VSD明显，主要集中在术毕至术后24 h较短时间内，未引起明显炎症反应。

Abstract:

OBJECTIVE: To study myocardial injury and inflammatory response within 7 days after interventional therapy in children with congenital heart disease (CHD). METHODS: A total of 77 children with CHD, including 12 cases of ventricular septal defect (VSD), 14 cases of atrial septal defect (ASD), 14 cases of pulmonary stenosis (PS) and 37 cases of patent ductus arteriosus (PDA), were enrolled. The levels of myocardial enzyme (AST, CK and CKMB), cardiac troponin I (cTnI) and CRP in serum were measured before operation, immediately after operation, and 6 hrs, 24 hrs, 72 hrs and 7 days after operation. RESULTS: Serum AST levels in the VSD group were significantly higher than the other CHD groups immediately after operation, and 6 hrs and 24 hrs after operation (P<0.05). There were significant differences in serum CK and CKMB levels among the four CHD groups immediately and 6 hrs after operation (P<0.05), and the highest serum CK and CKMB levels were found in the VSD group. Serum CRP levels in the PDA group were significantly higher than the other CHD groups 72 hrs and 7 days after operation (P<0.05). Compared with before operation, serum AST levels increased significantly in all four CHD groups 6 and 24 hrs after operation groups (P<0.05). Serum CK and CKMB levels increased significantly in the VSD group immediately and 6 hrs after operation (P<0.05). Serum cTnI levels increased significantly in the VSD, PDA and PS groups immediately and 6 hrs after operation (P<0.05). The PDA group showed increased CRP levels 24 hrs, 72 hrs and 7 days after operation (P<0.05). CONCLUSIONS: Minor myocardial injury can be noted within 7 days after interventional therapy in children with CHD and mainly occurs between immediately and 24 hrs after operation. The injury is more significant in VSD cases. The interventional therapy does not cause significant inflammation.