Increased Plasma Norepinephrine Levels in Infants and Children with Congestive Heart Failure

鬱血性心臓衰竭病童正腎上髓素變化之特性

吳俊仁(Jiunn-Ren Wu) ； 張慧柔(Huoy-Rou Chang) ； 黃德揚(Teh-Yang Huang) ； 陳順勝(Shun-Sheng Chen)

《Acta Paediatrica Sinica》 36卷5期 (1995/10) Pp. 351-356

https://doi.org/10.7097/APS.199510.0351

摘要

目的：本研究希望能夠針對患有先天性心臓病病童，測量血漿中正腎上髓素(norepinephrine)及腎上髓素(epinephrine)濃度，找出其在先天性心臓病人及併發鬱血性心臓衰竭者之變化及其關系。
病人：本研究對象分爲四組；A組，對照組，27人；B組，先天性心臓病而無分流者15人；C組，先天性心臓病有左到右分流而無心臓衰竭者36人；D組，併發心臓衰竭者43人。D組，再依心臓衰竭嚴重度分爲輕度衰竭DI，15人；中度衰竭DII，12人；重度衰竭DIII，16人。
方法：抽血10 ml，離心後取其血漿，以高壓氣向層析法(high performance liquid chromatography)測量正腎上髓素及腎上髓素之濃度，並將其數值分析。比較鬱血性心臓衰竭臨床分類，58位心導管病人之肺對體循環分流量(Qp/Qs)，及肺對體循環壓力比(Pp/Ps)之關系。並追蹤15位開心手術病人血中數值之變化。
結果：D組血漿中正腎上髓素比(B+C)組明顯上昇(704±232 pg/ml比274±68/ml，p＜0.001)，而其數值在DI，DII，DIII，也比對照組分別高出2.0，2.6，及3.7倍。而腎上髓素各組間並沒明顯差異，正腎上髓素濃度與Qp/Qs及Pp/Ps程度也呈正性直接關系(r=0.46及r=0.67,p＜0.001)。手術後1-3個月，正腎上髓素也明顯降低(765±209 pg/ml比376±105 pg/ml，p＜0.001)。
結論：血漿中正腎上髓素與心臓衰竭臨床症狀及血行力學變化中之Qp/Qs及Pp/Ps嚴重程度有良好相關性，可做爲兒童先天性心臓病中有否心臓衰竭及嚴重程度在檢驗學上之指標。

關鍵字

正腎上髓素 ； 心臓衰竭 ； 先天性心臓病 ； 心臓手術

並列摘要

To characterize the changes in circulating catecholamine levels for children with varying degrees of congestive heart failure (CHF), plasma norepinephrine (NE) and epinephrine (E) levels were measured, using high performance liquid chromatography, in 94 noncyanotic congenital heart disease patients. Plasma NE levels in 43 patients with CHF were signficantly higher than those in the 51 patients without CHF (704±68 pg/ml vs 274±68 pg/ml, p＜0.00l). Compared with the controls, the NE levels in the mild, moderate and severe CHF subgroups increased by 2.0, 2.6 and 3.7 fold, respectively. The E concentration did not significantly vary among the groups. The plasma NE levels correlated directly with the degree of left-to-right shunt (r=0.46, p＜0.00l) and pulmonary systolic pressure (r=0.67, p＜0.001). Thus, a highly significant association was found between the level of plasma NE and severity of CHF symptoms. A follow-up study of 15 of the 30 CHF patients after surgery disclosed a significant decline in plasma NE (p＜0.001). The results of this study clearly demonstrate that plasma NE levels parallel the presence and severity of CHF in infants and children.

並列關鍵字

norepinephrine ； congestive heart failure ； congenital heart disease ； heart surgery