先天性心脏病伴肺动脉高压患儿围术期中性粒细胞明胶酶相关脂质运载蛋白水平的变化

Perioperative change in serum neutrophil gelatinase-associated lipocalin level among children with congenital heart disease and pulmonary hypertension

摘要:

目的：探讨先天性心脏病（CHD）合并肺动脉高压患儿手术前后中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平的变化及意义。方法：将80例CHD患儿按其肺动脉收缩压分为4组：无肺动脉高压组及轻、中、重度肺动脉高压组。测定各组术前、术后即刻、术后24 h血清NGAL含量,分析血清NGAL含量与肺动脉高压及早期预后的关系。结果：CHD伴轻、中、重度肺动脉高压患儿血清NGAL含量均高于不伴肺动脉高压组,血清NGAL浓度随着肺动脉高压程度的加重而升高（P<0.01）。各组患儿术后血清NGAL含量均较术前降低（P<0.01）。血清NGAL含量与肺动脉高压的程度、重症监护病房滞留时间呈正相关（P<0.01）。结论：CHD所致肺动脉高压时，血清NGAL浓度增高；手术中止异常分流后，血清NGAL浓度逐渐降低。血清NGAL水平或可作为衡量肺动脉高压程度和评价手术效果的血清学参考指标。

Abstract:

OBJECTIVE: To study the perioperative change in serum neutrophil gelatinase-associated lipocalin (NGAL) level among children with congenital heart disease (CHD) and pulmonary hypertension (PH) and its significance. METHODS: Eighty children with CHD were divided into four groups according to pulmonary artery systolic pressure: non-PH, mild PH, moderate PH and severe PH groups. Serum NGAL levels were measured before operation, immediately after operation and 24 hours after operation. The relationship of serum NGAL level with PH and early prognosis was analyzed. RESULTS: The mild, moderate and severe PH groups had significantly higher serum NGAL levels than the non-PH group, and the severer the PH, the higher the serum NGAL level (P<0.01). All groups showed significant decreases in serum NGAL levels after operation (P<0.01). Serum NGAL level was positively correlated with the degree of PH and length of stay in the intensive care unit (P<0.01). CONCLUSIONS: Serum NGAL level increases in children with CHD and PH, and it gradually decreases after operation for closing the abnormal shunt. Serum NGAL level may be used as a serological indicator for evaluating the degree of PH and surgical outcome.