文章摘要
郭 军,赵 胜,黄晓碧,杨贵明,祁晓慧.先天性心脏病患儿介入封堵术治疗前后CRP、NT-proBNP、心率变异性的变化及与术后心功能的关系研究[J].,2022,(9):1760-1765
先天性心脏病患儿介入封堵术治疗前后CRP、NT-proBNP、心率变异性的变化及与术后心功能的关系研究
Changes of CRP, NT-proBNP, Heart Rate Variability and their Relationship Research with Postoperative Cardiac Function in Children with Congenital Heart Disease before and after Interventional Closure
投稿时间:2021-10-05  修订日期:2021-10-27
DOI:10.13241/j.cnki.pmb.2022.09.032
中文关键词: 先天性心脏病  介入封堵术  C-反应蛋白  N末端B型利钠肽原  心率变异性  心功能
英文关键词: Congenital heart disease  Interventional closure  C-reactive protein  N-terminal pro-B-type natriuretic peptide  Heart rate variability  Cardiac function
基金项目:安徽省卫生计生委科研计划项目(2017ek004)
作者单位E-mail
郭 军 安徽省儿童医院心内科 安徽 合肥 230000 guoan085@163.com 
赵 胜 安徽省儿童医院心内科 安徽 合肥 230000  
黄晓碧 安徽省儿童医院心内科 安徽 合肥 230000  
杨贵明 安徽省儿童医院心内科 安徽 合肥 230000  
祁晓慧 安徽省儿童医院心内科 安徽 合肥 230000  
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中文摘要:
      摘要 目的:探讨先天性心脏病(CHD)患儿介入封堵术治疗前后C-反应蛋白(CRP)、N末端B型利钠肽原(NT-proBNP)、心率变异性(HRV)的变化及与术后心功能的关系。方法:选择2020年10月至2021年6月在本院行介入封堵术治疗的95例CHD患儿为研究对象,采用化学发光法检测血清CRP水平,采用电化学发光免疫技术检测血清NT-proBNP水平,采用24 h动态心电图及12导联同步心电图分析HRV指标,观察手术前后患儿的血清CRP、NT-proBNP水平及HRV指标变化,比较术后不同NYHA心功能分级患儿的血清CRP、NT-proBNP水平和HRV指标,分析患儿术前血清CRP水平、血清NT-proBNP水平、HRV指标与术后NYHA心功能分级的相关性。结果:介入封堵术后患儿血清CRP、NT-proBNP、LF/HF水平逐渐降低,术后3 d、术后1个月时均低于术前,术后1个月时均低于术后3 d时(P<0.025);而TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平逐渐升高,术后3 d、术后1个月时均高于术前,术后1个月时均高于术后3 d 时(P<0.025)。患儿术后3 d的血清CRP、NT-proBNP水平及LF/HF水平随着NYHA心功能分级的升高而升高,TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平随着NYHA心功能分级的升高而降低(多有P<0.05)。患儿术后3 d的NYHA心功能分级与治疗前血清CRP、NT-proBNP及LF/HF水平呈负相关,与TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平呈正相关(P<0.05)。结论:CHD患儿经介入封堵术治疗后,血清CRP、NT-proBNP及HRV指标变化明显,与术后NYHA心功能分级显著相关,血清CRP、NT-proBNP及HRV指标有望成为评估CHD患儿介入封堵术后预后的较敏感性指标。
英文摘要:
      ABSTRACT Objective: To investigate the changes of C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), heart rate variability (HRV) and their relationship with postoperative cardiac function in children with congenital heart disease (CHD) before and after interventional closure. Methods: From October 2020 to June 2021, 95 children with CHD who received interventional occlusion in our hospital were selected as the research subjects. The serum CRP level was detected by chemiluminescence method, the serum NT-proBNP level was detected by electrochemiluminescence immunoassay, the HRV indexes were analyzed by 24 h ambulatory electrocardiogram and 12 lead synchronous electrocardiogram, and the changes of serum CRP, NT proBNP levels and HRV indexes before and after operation were observed. The serum CRP, NT-probNP levels and HRV indexes were compared before and after operation, and the serum CRP, NT-probNP levels and HRV indexes of children with different NYHA cardiac function grades after operation were compared. The correlation between preoperative serum CRP level, serum NT-probNP level, HRV index and postoperative NYHA cardiac function grading were analyzed. Results: The serum CRP, NT-proBNP and LF/HF levels in children with CHD after interventional occlusion decreased gradually, which at 3 days and 1 month after operation were lower than those before operation, and 1 month after operation were lower than those 3 days after operation(P<0.025). The TP, HF, LF, R-R, PNN50%, ASDNN, SDANN, SDNN and rMSSD levels increased gradually, which at 3 days and 1 month after operation were higher than those before operation, and 1 month after operation were higher than those 3 days after operation(P<0.025). The serum CRP, NT-probNP and LF/HF levels in children with CHD at 3 d after operation increased with the increase of NYHA cardiac function grading. The TP, HF, LF, R-R, PNN50%, ASDNN, SDANN, SDNN and rMSSD levels decreased with the increase of NYHA cardiac function grading (most have P<0.05). The NYHA cardiac function grading of children with CHD at 3 d after operation was negatively correlated with the CRP, NT-proBNP and LF/HF levels in serum before treatment(P<0.05), and positively correlated with the TP, HF, LF, R-R, PNN50%, ASDNN, SDANN, SDNN and rMSSD levels(P<0.05). Conclusion: After interventional closure, the indexes of serum CRP, NT-proBNP and HRV in children with CHD changed significantly, which are significantly correlated with the postoperative NYHA cardiac function grade. The indexes of serum CRP, NT-proBNP and HRV are expected to be sensitive indexes to evaluate the prognosis of children with CHD after interventional occlusion.
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