血浆NO、cGMP在小儿左向右分流先天性心脏病中的表达水平及与预后的关系

摘要
图/表
参考文献
相关文章 (2)

全文: PDF (2857 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的：探讨血浆一氧化氮（NO）、环磷酸鸟苷（cGMP）在小儿左向右分流先天性心脏病中的表达水平及与预后的关系。方法：回顾性选取我院2018年1月―2021年5月小儿左向右分流先天性心脏病患儿114例,均接受手术治疗,根据术后6个月预后情况分为预后良好组（92例）与预后不良组（22例）。比较两组患者临床资料、血浆NO、cGMP水平,分析血浆NO、cGMP与病情的相关性,评价血浆NO、cGMP对预后的影响及预测价值。结果：预后不良组心功能分级、术后危重程度评分、合并肺动脉高压比例高于预后良好组;预后不良组血浆NO、cGMP水平低于预后良好组;心功能分级Ⅳ级患儿血浆NO、cGMP水平<Ⅲ级患儿<Ⅱ级患儿;术后危重程度较高患儿血浆NO、cGMP水平低于危重程度较低患儿;合并肺动脉高压患儿血浆NO、cGMP水平低于未合并肺动脉高压患儿;血浆NO、cGMP水平与心功能分级、术后危重程度、合并肺动脉高压呈负相关;血浆NO、cGMP低水平会显著增加小儿左向右分流先天性心脏病患儿预后不良风险,OR值分别为2.563、1.921,95%CI分别为1.840~3.570、1.372~2.691;血浆NO、cGMP水平联合预测小儿左向右分流先天性心脏病患儿预后不良的AUC为0.929（95%CI：0.865~0.969）,约登指数为0.811,大于两者单独预测。结论：血浆NO、cGMP在小儿左向右分流先天性心脏病中呈下调表达,与病情密切相关,会增加预后不良风险,联合预测预后不良价值较为可靠。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	汤荣宁
	唐文琳

关键词 ：小儿左向右分流先天性心脏病, 一氧化氮, 环磷酸鸟苷, 预后情况, 预测价值

Abstract：Objective To investigate the expression levels of plasma nitric oxide（NO）and cyclic guanosine phosphate（cGMP）in children with left-to-right shunt congenital heart disease and their relationship with prognosis. Methods A total of 114 children with left-right shunt congenital heart disease in our hospital from January 2018 to May 2021 were retrospectively selected,all of whom received surgical treatment,and were divided into good prognosis group（92 cases）and poor prognosis group（22 cases）according to the prognosis 6 months after surgery. The clinical data,plasma NO and cGMP levels of the two groups were compared,the correlation between plasma NO and cGMP and the disease was analyzed,and the influence and predictive value of plasma NO and cGMP on the prognosis was evaluated. Results The heart function grade,postoperative severity score and the proportion of pulmonary hypertension in the poor prognosis group were higher than those in the good prognosis group. Plasma levels of NO and cGMP in poor prognosis group were lower than those in good prognosis group. The levels of plasma NO and cGMP in grade Ⅳ children were lower than those in grade Ⅲ children than those in grade Ⅱ children;The plasma levels of NO and cGMP in children with higher severity were lower than those in children with lower severity. The plasma levels of NO and cGMP in children with pulmonary hypertension were lower than those in children without pulmonary hypertension. Plasma NO and cGMP levels were negatively correlated with cardiac function grade,postoperative severity and pulmonary hypertension. Low levels of plasma NO and cGMP significantly increased the risk of poor prognosis in children with left-to-right shunt congenital heart disease. The OR values were 2.563 and 1.921,respectively,and 95%CI were 1.840-3.570 and 1.372-2.691,respectively. Combined plasma NO and cGMP levels predicted poor prognosis of children with left-right shunt congenital heart disease with AUC of 0.929（95%CI：0.865~0.969）and Yoden index of 0.811,which were greater than those predicted by the two alone. Conclusion Plasma NO and cGMP are down-regulated in children with left-to-right shunt congenital heart disease,which is closely related to the disease and will increase the risk of poor prognosis,and the combined prediction of poor prognosis is reliable.

Key words： left to right shunt congenital heart disease in children nitric oxide cyclic guanosine phosphate prognosis predictive value

收稿日期: 2023-04-19

中图分类号:

R725.4

通讯作者: 唐文琳,E-mail：tesia625@163.com

引用本文:

汤荣宁, 唐文琳. 血浆NO、cGMP在小儿左向右分流先天性心脏病中的表达水平及与预后的关系[J]. 湖南师范大学学报(医学版), 2023, 20(5): 79-83. TANG Rongning, TANG Wenlin. The expression levels of plasma NO and cGMP in children with left-to-right shunt congenital heart disease and their relationship with prognosis. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(5): 79-83.

链接本文:

http://yxb.hunnu.edu.cn/CN/ 或 http://yxb.hunnu.edu.cn/CN/Y2023/V20/I5/79

[1] Taksande A,Jameel PZ.Critical Congenital Heart Disease in Neonates:A Review Article[J]. Curr Pediatr Rev,2021,17(2):120-126.
[2] Lewis-Israeli YR,Wasserman AH,Gabalski MA,et al.Self-assembling human heart organoids for the modeling of cardiac development and congenital heart disease[J]. Nat Commun,2021,12(1):5142.
[3] Houska N,Twite MD,Ing RJ.The Importance of the Airway in Children Undergoing Surgery for Congenital Heart Disease[J]. J Cardiothorac Vasc Anesth,2021,35(1):145-147.
[4] Czobor NR,Ocsovszky Z,Roth G,et al.ADHD symptomatology of children with congenital heart disease 10 years after cardiac surgery:the role of age at operation[J]. BMC Psychiatry,2021,21(1):316.
[5] 阴文超,钱金桥. 一氧化氮的心脏保护作用研究进展[J]. 国际麻醉学与复苏杂志,2019,40(2):185-189.
[6] 葛甜,杨倩. 特异性危重程度评分在先天性心脏病患儿术后的应用研究[J]. 西南国防医药,2020,30(9):833-835.
[7] 任洁,熊小雨,刘成军,等. 先天性心脏病术后患儿血管活性药物评分与其预后关系[J]. 中华胸心血管外科杂志,2018,34(3):139-143.
[8] German Society of Paediatric Cardiology. Guidelines for the Management of Congenital Heart Diseases in Childhood and Adolescence[J]. Cardiol Young,2017,27(S3):S1-S105.
[9] Greenberg JH,McArthur E,Thiessen-Philbrook H,et al. Long-term Risk of Hypertension After Surgical Repair of Congenital Heart Disease in Children[J]. JAMA Netw Open,2021,4(4):e215237.
[10] Zaqout M,Vandekerckhove K,De Wolf D,et al.Determinants of Physical Fitness in Children with Repaired Congenital Heart Disease[J]. Pediatr Cardiol,2021,42(4):857-865.
[11] 王晓峰,鲁中原,沈瑞环,等. 吸入一氧化氮改善肺血减少型紫绀型先天性心脏病术后血流动力学的研究[J]. 中国胸心血管外科临床杂志,2021,28(12):1461-1465.
[12] de la Fuente-Alonso A,Toral M,Alfayate A,et al. Aortic disease in Marfan syndrome is caused by overactivation of sGC-PRKG signaling by NO[J]. Nat Commun,2021,12(1):2628.
[13] Toral M,de la Fuente-Alonso A,Campanero MR,et al. The NO signalling pathway in aortic aneurysm and dissection[J]. Br J Pharmacol,2022,179(7):1287-1303.
[14] 唐汉庆,王兵,廉春容,等. 铁皮石斛多糖对冠心病缓慢性心律失常大鼠NO、cGMP及Na+-K+-ATP酶活性的影响[J]. 动物医学进展,2016,37(12):77-81.
[15] Zhao D,Guallar E,Vaidya D,et al.Cyclic Guanosine Monophosphate and Risk of Incident Heart Failure and Other Cardiovascular Events:the ARIC Study[J]. J Am Heart Assoc,2020,9(2):e013966.
[16] 陈峰,韩霞,李雪莹. 先天性心脏病患儿心内直视手术围手术期血浆NO/cGMP 通路分子的变化以及与血流动力学的相关性分析[J]. 中国循证心血管医学杂志,2018,10(9):1087-1090+1094.
[17] 廖梦阳,袁璟,廖玉华. 鸟苷酸环化酶刺激剂联合RAS阻滞剂开启心力衰竭治疗新途径[J]. 临床心血管病杂志,2021,37(8):687-691.
[18] Degjoni A,Campolo F,Stefanini L,et al.The NO/cGMP/PKG pathway in platelets:The therapeutic potential of PDE5 inhibitors in platelet disorders[J]. J Thromb Haemost,2022,20(11):2465-2474.
[19] 李青宴,黄艳华,沈磊. cGMP及其介导的信号通路在血小板聚集中的作用的研究进展[J]. 中国现代应用药学,2021,38(23):3045-3049.
[20] Triposkiadis F,Xanthopoulos A,Skoularigis J,et al.Therapeutic augmentation of NO-sGC-cGMP signalling:lessons learned from pulmonary arterial hypertension and heart failure[J]. Heart Fail Rev,2022,27(6):1991-2003.
[21] Friebe A,Sandner P,Schmidtko A. cGMP:a unique 2nd messenger molecule - recent developments in cGMP research and development[J]. Naunyn Schmiedebergs Arch Pharmacol,2020,393(2):287-302.