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目的评价血清脑利钠肽(BNP)和右室长轴二维整体收缩期应变(GLS)及应变率(GLSR)对小儿先天性心脏病(CHD)合并肺动脉高压(PAH)的诊断价值。方法左向右分流型先心患儿65例分为无PAH(B组,17例)和PAH(A组,48例)两组;30例健康体检者作为正常对照(C)组。血清BNP用ELISA法测定,保存二维图像分析右室功能。结果 A组血清BNP浓度明显高于B组和C组(P<0.01),并随着肺动脉高压程度的加重而增高。右室GLS、GLSR在A组明显低于B组和C组(P<0.01),GLS随着肺动脉压力程度升高而下降。血清BNP浓度与肺动脉收缩压(PASP)呈正相关(P<0.01)和左向右分流比率(Qp/Qs)呈正相关(P<0.05)。血清BNP与GLS或GLSR呈负相关(P<0.01或P<0.05)。结论血清BNP可以反映左向右分流先心病的容量和压力负荷,可作为先天性心脏病的辅助诊断及疾病严重性评估的客观指标。二维右心室应变和应变率能恰当地评估右心室整体和局部功能。
Objective To evaluate the diagnostic value of two-dimensional global systolic strain (GLS) and strain rate (GLSR) of serum brain natriuretic peptide (BNP) and right ventricular long axis in children with congenital heart disease (CHD) and pulmonary hypertension (PAH) Methods Sixty-five children with left-to-right shunt were divided into two groups: PAH without PAH (group B, n = 17) and PAH (group A, n = 48). Serum BNP was measured by ELISA and preserved in 2-D images for right ventricular function. Results The serum BNP level in group A was significantly higher than that in group B and C (P <0.01), and increased with the degree of pulmonary hypertension. Right ventricular GLS, GLSR in group A was significantly lower than those in group B and group C (P <0.01), and GLS decreased as pulmonary arterial pressure increased. Serum BNP concentration was positively correlated with pulmonary artery systolic pressure (PASP) (P <0.01) and left-to-right shunt ratio (Qp / Qs) (P <0.05). Serum BNP was negatively correlated with GLS or GLSR (P <0.01 or P <0.05). Conclusions Serum BNP can reflect the capacity and pressure load of left-to-right shunt congenital heart disease, and can be used as an objective indicator for the diagnosis of congenital heart disease and the evaluation of disease severity. Two-dimensional right ventricular strain and strain rate can properly assess the overall right and left ventricular function.