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

Changes in serum chromogranin A and urotensin II levels in children with chronic heart failure

摘要:

目的 探讨嗜铬粒蛋白A （CgA）、尾加压素Ⅱ （UⅡ）在慢性心力衰竭 （CHF）患儿血清中的变化及意义。方法 选取58例CHF患儿为心衰组，其中心内膜弹力纤维增生症17例，扩张型心肌病41例；另选取门诊健康体检儿童20例为对照组。采用酶联免疫吸附法 （ELISA法）测定血清CgA及UⅡ水平；采用双向侧流免疫法测定氨基末端脑钠肽前体 （NT-proBNP）水平；超声心动图测定心室重塑指标；Pearson相关或Spearman秩相关分析血清CgA、UⅡ与心室重塑的相关性。结果 心功能Ⅱ级患儿的血清CgA、NT-proBNP水平与对照组的差异无统计学意义 （P > 0.05）；CgA、NT-proBNP水平在心功能Ⅲ级、Ⅳ级患儿中高于对照组，并且随着心功能损害加重而升高 （P < 0.05）。UⅡ浓度在心功能Ⅱ级、Ⅲ级、Ⅳ级患儿中均低于对照组，并且随着心功能损害加重而逐渐降低，差异有统计学意义 （P < 0.05）。心内膜弹力纤维增生症与扩张型心肌病患儿间血清CgA、UⅡ水平的差异无统计学意义 （P > 0.05）。血清CgA浓度分别与左心室质量分数 （LVMI）、NT-proBNP、心功能分级成正相关 （r分别为0.279、0.649及0.778，P < 0.05），与左室射血分数 （LVEF）、左室短轴缩短率 （LVFS）、UⅡ成负相关 （r分别为-0.369、-0.322及-0.718，P < 0.05）。血清UⅡ分别与NT-proBNP、心功能分级成负相关 （r=-0.472、-0.591，P < 0.05），而与LVMI、LVEF、LVFS无明显相关性 （P > 0.05）。结论 CgA可能参与CHF患儿心室重塑，血清CgA和UⅡ有可能为心衰的诊断和心功能判断提供参考。

Abstract:

Objective To examine the changes in serum chromogranin A (CgA) and urotensin II (U II) levels in children with chronic heart failure (CHF) and their clinical significance. Methods A total of 58 children with CHF, among whom 17 had endocardial fibroelastosis (EFE) and 41 had dilated cardiomyopathy (DCM), were selected as CHF group, and 20 healthy children were selected as control group. Serum levels of CgA and U II were measured using enzyme-linked immunosorbent assay, and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined by bi-directional lateral flow immunoassay. Ventricular remodeling indices were measured using echocardiography. The correlation between serum CgA and U II levels and ventricular remodeling was evaluated by Pearson correlation or Spearman's rank correlation analysis. Results There were no significant differences in serum CgA and NT-proBNP levels between children with grade II heart function and the control group (P > 0.05). However, the serum CgA and NT-proBNP levels gradually increased as the heart function grade increased, and were significantly higher in grade III and IV children compared to those in the control group (P < 0.05). U II levels were lower in children with grade II, III, or IV heart function than those in the control group (P < 0.05), and significantly decreased with the aggravation of CHF (P < 0.05). There were no significant differences in CgA and U II levels between patients with EFE and DCM (P > 0.05). Serum CgA concentration was positively correlated with left ventricular mass index (LVMI), NT-proBNP, and cardiac function classification (r=0.279, 0.649, and 0.778 respectively; P < 0.05), but was negatively correlated with left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and U II (r=-0.369, -0.322, and -0.718 respectively; P < 0.05). Serum U II concentration was negatively correlated with NT-proBNP and cardiac function classification (r=-0.472 and -0.591 respectively; P < 0.05), but was not correlated with LVMI, LVEF, and LVFS (P > 0.05). Conclusions CgA may play a role in ventricular remodeling in children with CHF. Serum CgA and U II may serve as a reference for the diagnosis and functional classification of heart failure.