Clinical Study Of Dynamic Observation Of Plasma HU-â…¡ And CGRP Before And After Transcatheter Occlusion Of Congenital Heart Disease Accompany With Pulmonary Hypertension

Background:Pulmonary hypertension is a common and serious complication of congenital heart disease.The pulmonary vascular structural remodeling as a result of a left-to-right shunt are well recognized and clearly contribute to the development of pulmonary hypertension.However, the mechanism of pulmonary hypertension induced by high pulmonary blood flow is still unclear.So far as we know,the balance between vasodilators and vasoconstrictors plays an important role in the progression of pulmonary hypertension.Human urotensin-II(hU-II)is a cyclic peptide recently cloned in man and present in human cardiac tissue and human arteries.More recently,urotensin-II(U-II)has been considered as the most potent mammalian vasoconstrictor identified so far.Calcitonin gene-related peptide(CGRP)is a non-adrenergic/non-cholinergic(NANC)peptide with potent vasodilator activity,it is generated from an alternatively spliced transcript of the calcitonin gene.CGRP is the most potent peptide vasodilator discovered thus far.Both U-II and CGRP have exhibited pronounced cardio-vascular actions.At present,study concerning dynamic observation of plasma concentration of hU-II and CGRP before and after interventional therapy has seldomly reported.Objective:This study was designed to investigate the effect and clinical significance of plasma human urotensin-II(hU-II)and calcitonin gene-related peptide(CGRP)on pulmonary hypertension(PHT)secondary to left-to-right shunt congenital heart disease by dynamic detecting their levels at the stage pre- and- post transcathter closure in patients suffered from congenital heart disease accompany with different extent pulmonary hypertension.Methods:82 cases with left-to-right shunt congenital heart disease were enrolled in our study who received transcatheter interventional therapy successfully in the transcatheter interventional therapy center of The 2^nd xiangya hospital of Central South University from April 2007 to January 2008.The subjects were divided into four groups according to their pulmonary artery systolic pressure that measured by Echocardiography as follow:non-pulmonary hypertension group(PASP<30mmHg,n=11);mild pulmonary hypertension group(30mmHg≤PASP < 50mmHg,n=22); moderate pulmonary hypertension group(50mmHg≤PASP < 70mmHg,n=29);severe pulmonary hypertension group(PASP≥70mm Hg,n=20).Blood samples were obtained on admisson and on the 24h,1week and 1month after transcatheter closure,respectively.Plasma hU-II and CGRP levels were measured by radioimmunoassay.Results:1.Concentration of plasma hU-II obtained from brachial vein in PHT groups before operation is significantly higher than that of the non-PHTgroup(P<0.01).There was significant difference about the plasma hU-II level before transcatheter closure in the three PHT groups(P<0.01), Along with an increase in PASP,the concentration of plasma hU-II elevated, the level of plasma hU-II in cases of mild PHT group< moderate PHT group < severe PHT group,(P<0.01).2.The plasma concentration of CGRP of brachial vein before operation in mild,moderate and severe PHT group is significantly lower than that of the non-PHT group(P<0.01)and the difference between mild group,moderate group and severe group is significant(P<0.01):level of plasma CGRP of severe PHT group < moderate PHT group