Study On The Effect Of Adrenomedullin, Urotensin-Ⅱ And Nitric Oxide On Pulmonary Hypertension Of Patients With Congenital Heart Disease

Objective: Study on the effect and clinical significance of adrenomedullin, urotensin-Ⅱ and nitric oxide on pulmonary hypertension, by detecting their levels of patients with congenital heart disease and pulmonary hypertension.Method: Fifty-two patients with congenital heart disease who had left-to-right shunt were selected randomly. Thirty patients were male, others were female. Their age ranged from ten months to thirty-two years (mean 9.9±3.7 years). There were 23 patients with VSD, 11 patients with ASD, 5 patients with PDA, 8 patients with VSD and ASD, 3 patients with VSD and PDA, 2 patients with ASD and PDA. All patients were performed successfully on radical operation, 3 patients with PDA were operated without cardiopulmonary bypass (CPB), 49 patients were operated with cardiopulmonary bypass (CPB).Fifty-two patients were divided three groups according to pulmonary artery systolic pressure(PASP) by Doppler echocardiography and measuring directly in operation: group A was not pulmonary hypertension(PASP<30mmHg, n=17); group B was mild pulmonary hypertension(PASP30-49mmHg, n=18); group C was heavy pulmonary hypertension(PASP≥50mmHg,n=17).The plasma levels of ADM and UⅡ were detected at each period by radioimmunoassay(RIA) method, serum levels of NO were detected by colorimetry. It was analyzed the changes of their levels before the operation ofheart, at once and 7 days after CPB termination and the interrelation between them and pulmonary artery pressure (PAP).Results: ?There is positive correlation between PAP and plasma level of ADM(r=0.8012, P<0.05). ?There is no correlation between PAP and plasma level of UII (P>0.05).@There is negative correlation between PAP and serum level of NO(r=—0.7348, PO.05). ? Plasma level of ADM of each group after CPB is lower than that of each group before operation. It is statistical difference only 7 days after CPB: group A(20.3±3.2pg/ml VS 32.8±4.6pg/ml, P>0.05)o ?Serum level of NO of each group after CPB is higher than that of each group before operation. It is statistical difference only in group A and group B at 7 days after CPB: group A((88.2±10.3 u mol/L VS 78.1 ±9.3 u mol/L, P<0.05), group B(76.5±8.1 n mol/L VS 64.8 + 7.5 u mol/L, /><0.05). It is no statistical difference in group C(P>0.05).Conclusions:1. Following up the degree of pulmonary hypertension, the plasma levels of ADM increase. There is positive correlation between PAP and plasma level of ADM. ADM plays an important role in the formation of pulmonary hypertension and restructure.2. Following up the degree of pulmonary hypertension, the plasma levels of UII don't change obviously. There is no correlation between PAP and plasma level of UII, but ADM may be play an important role in the formation of pulmonary hypertension and restructure.3. Following up the degree of pulmonary hypertension, the serum levels of NO reduce. There is negative correlation between PAP and serum level of NO. NO plays an important role in the formation of pulmonary hypertension and restructure.