摘要
目的:探讨先天性心脏病(CHD)合并肺动脉高压(PH)患者手术前后硫化氢(H2S)及血红素氧合酶-1(HO-1)变化的临床意义。方法:采集河北医科大学第四医院心脏外科收治的48例左向右分流的CHD患者。48例患者均在静吸复合麻醉中成功实施了根治手术。48例患者经心脏多普勒进行术前测压,按照肺动脉收缩压(PASP)分为3组:A组,无PH组(PASP<30mmHg)15例;B组,轻度PH组(PASP30-49mmHg)15例;C组,中重度PH组(PASP≥50mmHg)18例。于手术前、手术后1h及手术后24h采集桡动脉血标本,用吸光度法于酶标仪670nm测定3组各时段血浆H2S含量;用双波长分光光度法测定3组各时段血清HO-1活性。结果:各组患者术后H2S含量呈上升趋势,但只有术后24h与术前比较有显著差异(P<0.05)。在术前、术后1h及术后24h:中重度PH组、轻度PH组血浆H2S含量均显著低于无PH组(P<0.05),中重度PH组血浆H2S含量均显著低于轻度PH组(P<0.05);每组患者在术前、术后1h、术后24h血清HO-1活性无显著差异;3组患者组间血清HO-1活性比较差异无显著。3组患者H2S含量与PASP呈负相关(术前r=-0.66,P<0.01;术后1hr=-0.458,P<0.01;术后24hr=-0.730,P<0.01)。3组患者HO-1活性与PASP无相关性(均P>0.05)。结论:H2S在PH形成和肺血管重建中发挥重要作用。HO-1与PASP无相关性,但不能排除HO-1在PH形成和肺血管重建中有重要作用。血浆H2S可作为判断PH严重程度的指标之一。
AIM： To evaluate the changes and clinical significance of hydrogen sulfide （H2S） and heme oxygenase - 1 （ HO - 1 ） in patients with congenital heart disease （CHD） and pulmonary hypertension （PH）. METHODS ： Forty - eight patients with CHD and left - to - right shunt were selected randomly from cardiac surgery in the Fourth Hospital of Hebei Medical University. Forty - eight patients were divided into 3 groups according to the pulmonary artery systolic pressure （PASP） by Doppler echocardiography before operation： group A was normal （PASP 〈 30 mmHg, n = 15 ） ; group B was mild PH （PASP 30 -49 mmHg, n = 15） ; group C was moderate - severe PH （PASP≥50 mmHg, n = 18）. The radical operation was performed successfully under complex intravenous anesthesia in all 48 patients. The radial arterial blood was collected immediately before operation, 1 h and 24 h after operation. The concentration of plasma H2 S was measured by optical absorbanee method at 670 nm and HO - 1 activity in serum was detected by dual wavelength spectrophotometer at different time points. RESULTS： Plasma level of H2S in all groups after operation was higher than that in the same group before operation. Significant difference of the plasma H2 S level was observed between pre - operation and 24 h post - operation in the same group （P 〈 0, 05 ）, The plasma level of H2S in group C and group B at time points of pre - operation, 1 h post -operation or 24 h post -operation was significantly lower than that in group A, the plasma level of H2S in group C was significantly lower than that in group B. Compared to the values in each group before operation, the activity of serum HO - 1 among groups after operation was not obviously and statistically different （ P 〉 0. 05 ）. No obvious difference of HO - 1 activity in blood among 3 groups was observed （P 〉 0. 05 ）. There was a negative correlation between PASP and the level of H2 S in 3 groups at time points of pre - operation, 1 h and 24 h post - operati
出处
《中国病理生理杂志》
CAS
CSCD
北大核心
2010年第7期1301-1305,共5页
Chinese Journal of Pathophysiology
基金
河北省科技厅科技支撑计划资助项目(No.0727611001)
关键词
肺动脉高压
心脏病
先天性
硫化氢
血红素氧合酶-1
Pulmonary hypertension
Heart disease, congenital
Hydrogen sulfide
Heme oxygenase - 1
