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。
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 gradeⅣchildren were lower than those in gradeⅢchildren than those in gradeⅡchildren;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.
作者
汤荣宁
唐文琳
TANG Rongning;TANG Wenlin(Department of Pediatrics,Ningde Municipal Hospital Of Ningde Normal University,Ningde 352100,China)
出处
《湖南师范大学学报（医学版）》
2023年第5期79-83,共5页
Journal of Hunan Normal University(Medical Sciences)
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
left to right shunt congenital heart disease in children
nitric oxide
cyclic guanosine phosphate
prognosis
predictive value
