Plasma Homocysteine Changes And Its Clinical Significance In Pulmonary Artery Hypertension Associated With Cogenital Heart Disease After Interventional Closure

Objective: The purpose of our study is to research the changes of the plasma HCY and its clinical significance in patients with PAH-CHD after interventions closure, and to analyze the correlation of HCY with hemodynamic parameters. Furthermore, it investigates the diagnosis of clinical significance for HCY in patients with PAH-CHD.Methods: Our study researched 104 patients with the left to right shunt CHD, and they had been implemented interventional closure successfully in our Cardiac intervention from January 2015 to December 2015 in the second affiliated hospital of Nanchang University. According to the difference of the mean pulmonary arterial pressure, we divided the CHD into four groups: CHD without PAH group(CHD-NPAH group, n=27);CHD with light PAH group(CHD-LPAH group n=32);CHD with moderate PAH group(CHD-MPAH group n=26);CHD with severe PAH group(CHD-PASP n=19); and 30 healthy patients were recruited as normal control group. We collected all clinical data of patients into objects; the size of aerial and ventricular were measured by echocardiographs and the hemodynamic parameters obtained cardiac catheterization. The HCY were detected by performance rate method.Results:(1) Plasma HCY concentrations of the PAH-CHD patients before interventions closure(CHD-LPAH group, CHD-MPAH group, CHD-SPAH group) were higher than the normal control group and CHD-NPAH group,all of the people's P < 0.05,and it had remarkable statistics meaning. According to the multiple comparison, the comparison among the CHD- LPAH group, CHD-MPAH group, and CHD-SPAH group all had statistic difference(p<0.05). Besides, the Plasma HCY of the patients with CHD-NPAH were higher than the normal control group, but the differences had no statistics meaning(p>0.05).(2) The Plasma HCY of the patients with CHD were significant higher than the normal control group(p<0.01). Although the HCY levels among the ASD,VSD and PDA groups were differences,but there were no statistical significance,P>0.05.(3)In the PAH-CHD,the serum HCY were positively correlation with PASP(r=0.283,P<0.05),MPAP(r=0.374,P<0.01) and PVR(r=0.347,P<0.01) before interventions closure.(4)When the serum HCY was 16.84umol/L, the CHD-SPAH may be have recognition ability. what's more, its sensibility was 79.3%, the specificity was 58.9%, and the area under the ROC curve was 0.778(p<0.11).(5) After the interventions closure, it was significant decreased that the serum HCY and pulmonary arterial pressure in postoperative of the patients with PAH-CHD. However, the serum HCY was still positively correlation with PASP(r=0.315,P<0.01).Conclusion:1. Our research suggests that the serum HCY concentration were significant elevated in PAH-CHD patients.2. On the whole, the serum HCY is positively correlation with PASP, MPAP, and PVR. Furthermore, in the diagnosis of CHD-PASP, the serum HCY concentration has stronger sensitivity, so the plasma HCY can be used as an adjunct to evaluate the severity of PAH-CHD patients.3. After the interventions closure, the serum HCY and pulmonary arterial pressure in postoperative of the patients with PAH-CHD are significant decreased, and there is still a linear relationship between them.So the intervention closure is an effective method to treat PAH-CHD and the plasma HCY concentration can be used as a biomarker in the follow-up evaluation of patients with PAH-CHD.