B型利鈉胜肽於先天性心臟病童重症照護之角色

The role of B-type natriuretic peptide in critical care of pediatric patients with congenital heart diseases

徐仲豪(Jong-Hau Hsu)

指導教授 ： 吳俊仁

高雄醫學大學/醫學院/醫學研究所/博士(2013年)

https://doi.org/10.6832/KMU.2013.00033

摘要

背景：Ｂ型利鈉胜肽(BNP)是一種具有32氨基酸可利鈉利尿及血管活化作用之荷爾蒙，目前已被廣泛使用成為心衰竭之生物標記。然而其在先天性心臟病重症照護之角色，以及其在先天性心臟病之生理作用，目前尚未被完全了解。
目的：1. 研究BNP於先天心臟病童重症照顧之角色。2. 研究BNP於肺血管系統抑制重塑造之作用。
方法：在臨床實驗中，我們前瞻性地研究BNP預測各類先天性心臟病其預後之能力。這些疾病種類包括：1. 接受心臟手術之新生兒（出生小於30天），2. 術後需要體外循環機支持之病人，3. 單一心室手術之病人（部分與完全大靜脈肺動脈吻合術），4. 患有開放性動脈導管之早產兒。在細胞實驗中，我們研究BNP作用於肺動脈血管平滑肌細胞中抑制增生與遷移的能力。
結果：在心臟病病童身上，我們發現血中BNP之濃度與其增加程度可預測新生兒、單一心室病人、術後接受體外循環機之病人與患有開放性動脈導管早產兒之不良預後。在細胞實驗中，我們發現BNP可抑制Angiotensin II 所引發之肺動脈血管平滑肌細胞之增生與遷移。而這些作用與其抗氧化、阻止鈣離子內移與MAPK訊息傳遞路徑有關，且這些抗重塑造之作用是藉由cGMP/PKG路徑所達成。
結論：在有先天性心臟病之新生兒、嬰兒與兒童之重症照護中，BNP是一個可有效預測病程之生物標記，且BNP於細胞實驗中可抑制肺血管之重塑造。因此，我們認為在未來需要有更多的研究對BNP於先天性心臟病之生理作用及相關機轉作進一步之探討。

關鍵字

先天性心臟病 ； Ｂ型利鈉胜肽血管重塑造

並列摘要

Background: B-type natriuretic peptide (BNP) is a 32 amino acid polypeptide hormone, with diuretic, natriuretic and vasoactive properties, which is widely used as a biomarker of congestive heart failure in adults. However, its role in critical care of congenital heart disease (CHD) is not fully elucidated. In addition, its physiologic role in CHD is unknown.

Purposes: 1) To investigate the role of BNP in the critical care of pediatric patients with CHD. 2) To determine its anti-remodeling effect on pulmonary vascular system in vitro.

Methods: In patients, we prospectively studied the ability of BNP in predicting outcome in several groups of CHD, including: 1) neonates (<30 days olds undergoing surgery, 2) patients required extracorporeal cardiac life support (ECLS) after surgery, 3) patients undergoing uni-ventricular repair (partial and total cavopulmonary anastomosis) and 4) premature neonates with patent ductus arteriosus (PDA). In vitro, we studied the anti-proliferative and anti-migratory effects of BNP in pulmonary arterial smooth muscle cell (PASMC).

Results: In pediatrics patients with CHD, we found perioperative plasma levels of BNP or its increase can predict poor outcomes in neonates undergoing cardiac surgery, children undergoing partial or total cavopulmonary anastomosis, patients receiving ECLS after surgery, and response to indomethacin in premature neonates. In vitro, we found BNP can prevent angiotensin II-induced proliferation and migration in PASMCs, via anti-oxidative, calcium influx and MAPK pathways. These anti-remodeling effects are mediated through cGMP/PKG pathway.

Conclusion: BNP is a valuable prognostic biomarker in the critical care of neonates, infants and children with CHD. In addition, BNP can inhibit pulmonary vascular remodeling in vitro and further studies are warranted to elucidate its physiologic role in CHD.

並列關鍵字

Congenital heart disease ； B-type natriuretic peptide ； vascular remodeling

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