标题：血管生成素-1和TNF-α在先心病肺动脉高压发病机制中的作用

      作者：宁巧明，欧阳碧山，张慧君，林慧，王颖    (海南省人民医院麻醉科，海南 海口 570311)

      卷次： 2018年29卷19期

      【摘要】 目的 探讨不同肺动脉压水平下的先天性心脏病(CHD)患者体外循环前后不同时间血管生成素-1 (Ang-1)和肿瘤坏死因子-α (TNF-α)水平的变化，进一步明确Ang1和 TNF-α与 CHD伴肺动脉高压(PH)的关系。方法 选取海南省人民医院2013年1月至2016年12月收治的CHD伴PH患者45例，利用酶联免疫吸附法测定患者(轻度PH、中度PH、重度PH各15例)麻醉前(T1)、麻醉后转机前(T2)、主动脉阻断30 min (T3)、主动脉开放30 min (T4)、术后1 d (T5)、术后7 d (T6) 6个时间点静脉血清中Ang-1和TNF-α的水平变化。结果 三组患者的Ang-1在T4开始降低，T5达到最低点，T4与其他时间点比较差异均有统计学意义(P<0.05)，T6恢复至麻醉前水平；三组患者不同时间点的Ang-1水平比较，差异均有统计学意义(P<0.05)；三组患者TNF-α均于T4时间点增加，T5开始降低，与其他时间点比较差异均有统计学意义(P<0.05)，T6恢复至麻醉前水平；三组患者不同时间点的TNF-α水平比较差异均有统计学意义(P<0.05)。结论 Ang-1和TNF-α与CHD患者PH的发生可能有关。
      【关键词】 先天性心脏病肺疾病；肺动脉高压；血管生成素-1；肿瘤坏死因子-α
      【中图分类号】 R541.1 【文献标识码】 A 【文章编号】 1003—6350（2018）19—2682—03

Effect of angiopoietin-1 and TNF-α in pathogenesis of pulmonary hypertension in patients with congenital heartdisease.
NING Qiao-ming, OUYANG Bi-shan, ZHANG Hui-jun, LIN Hui, WANG Ying. Department of Anesthesia, HainanGeneral Hospital, Haikou 570311, Hainan, CHINA
【Abstract】 Objective To investigate the changes of the levels of angiopoietin 1 (Ang1) and tumor necrosisfactor α (TNF-α) in patients with congenital heart disease (CHD) under different levels of pulmonary arterial pressure(PH) at different time with cardiopulmonary bypass (CPB), to further clarify the relationship between Ang1 and TNF-αand pulmonary hypertension. Methods A total of 45 patients with PH (15 cases of mild PH, moderate PH and 15 casesof severe PH), who admitted to Hainan General Hospital from January 2013 to December 2016, were selected as the re-search subjects. Ang1 and TNF-α were measured by enzyme-linked immunosorbent assay (ELISA) at the time of be-fore anesthesia (T1), CPB after anesthesia (T2), aortic occlusion 30 minutes (T3), aortic opening 30 minutes (T4), oneday after the operation (T5), 7 days after the operation (T6). Results The Ang1 levels of the three groups began to de-crease at T4, reached the lowest point at T5, with the differences between T4 and other time points statistically signifi-cant (P<0.05), and returned to the pre-anesthesia level at T6. There were significant differences in Ang1 levels amongthe three groups at different time points (P<0.05). The TNF-α levels of the three groups began to increase at T4, beganto decrease at T5, with the differences between T4 and T5 and other time points statistically significant (P<0.05), andreturned to the pre-anesthesia level at T6 (P<0.05). There were significant differences in TNF-α levels among the threegroups at different time points (P<0.05). Conclusion Ang1 and TNF-α are related to the occurrence of PH in pa-tients with CHD.
      【Key words】 Congenital heart disease (CHD); Pulmonary hypertension (PH), Angiopoietin 1 (Ang1); Tumor ne-crosis factor α (TNF-α)·论 著·doi:10.3969/j.issn.1003-6350.2018.19.005基金项目：海南省自然科学基金(编号：812152)