Study On The Changes Of B Type Natriuretic Peptide And Adrenomedullin Before And After The Interventional Therapy With Congenital Heart Disease

Objective:To observe the changes of B type natriuretic peptide and adrenomedullin before and after the interventional therapy with congenital heart disease (CHD), analyze their effects on the physiology and pathology of CHD, and explore the evaluation and prediction values on the changing of heart function and pulmonary artery pressure before and after interventional therapy.Methods:Ninty patients with CHD, including40males and50females, aged1-10years,were treated by interventional therapy in the First Hospital of Hebei Medical University from October2011to December2012,and then enrolled in this study.There were29cases of patent ductus arteriosus(PDA),40cases of atrial septal defect(ASD) and21cases of ventricular septal defect (VSD). There was a control group including30cases of normal children who were undergone physical examination in the Regular Physical Examination Centre of the First Hospital of Hebei Medical University. Four milliliters venous blood were respectively extracted before the interventional therapy,24hours,3days and3months after the interventional therapy from all the subjects.The samples were placed in the anticoagulation tube containing30ul of EDTA-2Na and40ul of aprotinin, then centrifugated in30minutes. The supernatants were collected and kept in-80℃refrigerator. The valuse of ADM and BNP were detected by special technician with Enzyme-linked immunosorbent assay.The diagnositic kits were provided by Hebei Bohai Biology Engineering Development Co.ltd.. Transtroracic echography were performed by special ultrasound doctors of the First Hospital of Hebei Medical University before interventional therapy,5days and3months after interventional therapy to evaluate the heart function of the subjects. Evaluation of cardiac function indicators include the diameter of right atrium(RAD), right ventricular (RVD), left atrium (LAD), left ventricle end-diastolic diameter (LVEDD), left ventricle end-systolic diameter (LVESD), left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESD), fractional shortening (FS) ejection fraction (EF) and systolic pulmonary artery pressure (PASP).SPSS13.0software pack was used to make statistical analysis. All the measurement date was denoted by mean±standard deriation.when the date were normal distribution and homoscedosticity. T test was performed to compare the difference between the values of two groups.Repeated measures analysis of variance was performed to compare the difference among the values of different time. Linear correlation analysis was used to analyze the correlation between two variables.The significant level is a=0.05.P<0.05means the difference is significant.Result:1The comparison of baseline characteristics between CHD group and control groupThe age of CHD group and control group was respectively4.33±2.13years and4.20±1.62years, there was no statistical defference between the two group about age and gender distribution(P>0.05).The height of CHD group and control group was respectively105.33±16.94centimeter and112.08±12.27centimeter, and the weight was respectively18.63±4.92kilogram and21.04±4.14kilogram.The height and the weight of CHD group were lower than the control group, and both of the differences were significant (P<0.05).(Table1)2The comparison of BNP and ADM before and after interventional therapy about CHD groupThe values of BNP and ADM about each time of preoperation and postoperation were significantly differencet (P<0.05).(Fig.1, Fig.2)About the CHD group, comparing with the control group,the value of BNP (84.31±22.10, ng/L) was higher(84.31±22.10vs52.49±17.14, ng/L), the difference was significant (P<0.05).About the BNP level,there was no significant different between the values of preoperation and24hours postoperation (84.31±22.10vs80.33±20.27, ng/L)(P>0.05). About3days after interventional therapy, the values of BNP (70.38±20.93, ng/L) began to decline gradually, and then lower than preoperation, the difference was statistically significant (P<0.05). The values of BNP3months after intervention (56.01±29.58, ng/L),was obviously lower than preoperation (P<0.05), and not significantly different to control group (P>0.05).(Table2)About the CHD group, comparing with the control group,the value of ADM (57.78±10.74, ng/L) was higher(57.78±10.74vs40.11±8.69, ng/L), the difference was significant (P<0.05).About the ADM level,there was no significant difference between the values of preoperation and24hours postoperation (57.78±10.74vs55.47±12.85, ng/L)(P>0.05). About3days after interventional therapy, the values of ADM (49.52±11.02, ng/L) began to decline gradually, the difference was statistically significant (P<0.05). The value of ADM3months after intervention (43.84±9.20, ng/L),was not significantly different from control group (P>0.05).(Table3)3Comparison of BNP and ADM among different types of CHDThe BNP level of PDA group was (86.72±25.44, ng/L) and the ADM was (61.29±9.94, ng/L). The BNP level of ASD group was (83.44±21.39, ng/L) And the ADM was (56.36±11.71, ng/L). The BNP level of VSD group was (82.63±19.03, ng/L) and the ADM was (55.66±9,02, ng/L).there were no significantly difference (P>0.05)(Table4).4The comparion of cardiac function and pulmonary artery pressure before and after interventional therapy about CHD groupThe changes of heart function and pulmonary arterial pressure before and after interventional therapy had statistical difference(P<0.05).(Table5)Compare with control group,the values of preoperation about LAD (24.17±2.55vs18.36±1.97, mm), LVESD (26.67±4.06vs20.96±1.69, mm), LVEDD (38.23±5.02vs32.79±7.21, mm), RAD (25.84±3.69vs23.92±4.12, mm, RVD (26.62±7.02vs22.11±2.09, mm), LVESV (20.77±4.71vs 15.06±2.07, mm), LVEDV (60.21±14.88vs49.16±15.78, ml), FS (35.29±8.45vs33.71±7.09,%), EF (64.61±6.41vs67.10±3.12,%) and PASP (29.08±1.36vs21.68±1.75, mmHg) were significantly difference(P<0.05).Compare with preoperation, the values of5days postoperation about LAD (22.04±2.71, mm), LVESD (24.35±2.94, mm), LVEDD (36.45±3.00, mm), RAD (24.78±4.17, mm), RVD (24.78±8.02, mm), LVESV (17.53±5.22, ml), LVEDV (52.40±13.70, ml), FS(35.08±9.03,%), EF (65.88±5.36,%)and PASP (25.85±1.60, mmHg) were significantly different (P<0.05) which means the heart function was improved.Compare with control group, the values of3months postoperation about LAD (18.58±1.92, mm), LVESD (21.36±1.84, mm), LVEDD (32.62±3.75, mm), RAD (24.83±2.39, mm), RVD (21.83±1.92, mm), LVESV (14.23±4.61, ml), LVEDV (48.45±13.89, ml), FS (34.32±5.71,%), EF (68.27±2.08,%)and PASP (22.12±1.67, mmHg)were not significantly different (P>0.05).5The relationship between BNP/ADM and cardiac function/pulmonary artery pressure of CHD group before and after the interventional therapyBefore interventional therapy,the BNP level and LAD was significantly correlated (P<0.05),the same as LVESD, LVEDD, LVESV, LVEDV, RVD and PASP. The BNP level and RAD was not significantly correlated (P>0.05),the same as FS and EF. The ADM level and LAD was significantly correlated (P<0.05),the same as LVESD, LVEDD, LVESV, RVD and PASP. The ADM level and RAD was not significantly correlated (P>0.05),the same as LVEDV and FS.(Fig.3)Three months after interventional therapy, the BNP level and LAD was significantly correlated (P<0.05),the same as LVESD, LVEDD, LVESV, RVD, RAD, EF,LVEDV and PASP. The BNP level and FS was not significantly correlated (P>0.05). The ADM level and LAD was significantly correlated (P<0.05),the same as LVESD, LVEDD, LVESV, RVD, LVEDV and PASP. The ADM level and RAD was not significantly correlated (P>0.05) and the same as FS.(Fig.4, Fig.5.1,Fig.5.2)(Table6)Conclusion: 1The BNP and ADM levels of patients with CHD were higher than that of the control group.The values of24hours postoperation have no obvious difference,but that of3days postoperation gradually decline,then close to that of the control group about3months after operation.2The cardiac function and pulmonary artery pressure of patients with CHD were obviously improved after interventional therapy, closed to that of the control group up to3months after intervention.3The BNP/ADM level was correlated with LAD, and their dynamic changes were closely related, and the same as BNP/ADM and LVEDD, RAD, EF and PASP.So the serum BNP and ADM can be considered as the prognostic evaluation basis on interventional therapy.