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目的 :探讨婴儿重症肺炎合并急性充血性心力衰竭 (婴儿肺炎并心衰 )时血浆内皮素 ( ET)水平变化的影响因素。方法 :用放射免疫分析法 ,同期动态观测了 2 6例肺炎并心衰患儿血浆 ET、降钙素基因相关肽( CGRP)及动脉血氧分压 ( Pa O2 )变化。结果 :心衰急性期 (治疗前 )血浆 ET含量较其自身缓解期 (治疗后 )、轻型肺炎组及正常对照组均显著增高 ( P均 <0 .0 1) ,而同期测定的血浆 CGRP含量及 Pa O2 值则较其自身缓解期及正常对照组均显著降低 ( P均 <0 .0 1) ;心衰缓解期与轻型肺炎组和正常对照组间血浆 ET、CGRP水平及Pa O2 值变化无统计学差异 ( P均 >0 .0 5 )。心衰急性期血浆 ET含量变化与血浆 CGRP水平呈显著负相关 ( P<0 .0 1) ,与 Pa O2 值亦至显著负相关 ( P<0 .0 1)。结论 :血浆 ET水平增高是促进婴儿重症肺炎合并心衰发生发展的重要因素 ;血浆 ET水平增高的原因可能与血浆 CGRP含量降低及 Pa O2 下降有关 ;动态监测血浆 ET及CGRP含量变化对判断病情及预后有重要临床意义。
Objective: To investigate the influencing factors of plasma endothelin (ET) level in severe pneumonia complicated with acute congestive heart failure (infantile pneumonia and heart failure). Methods: The changes of plasma ET, CGRP and Pa O2 in 26 children with pneumonia and heart failure were observed dynamically by radioimmunoassay in the same period. Results: In the acute phase of heart failure (before treatment), plasma ET level was significantly higher than that in the patients with self-remission (after treatment), mild pneumonia group and normal control group (all P <0.01), while plasma CGRP level (P <0.01). The levels of plasma ET and CGRP and the changes of Pa O2 in patients with mild pneumonia and normal controls were significantly lower than those in patients with remission and normal control (P <0.01) No statistical difference (P> 0.05). There was a significant negative correlation between plasma endothelin (ET) level and plasma CGRP levels in acute phase of heart failure (P <0.01), and negatively correlated with Pa O2 level (P <0.01). Conclusion: Increased plasma ET level is an important factor to promote the development of severe pneumonia complicated with heart failure in infants. The reason for the increased plasma ET level may be related to the decrease of plasma CGRP level and the decrease of Pa O2 level. Prognosis has important clinical significance.