Clinical Observation Of Direct Bilirubin In Patients With Congenital Heart Disease Complicated With Pulmonary Hypertension

Background and ObjectivePulmonary arterial hypertension is a pathophysiological condition caused by one or more known or unknown causes of abnormal pulmonary arterial pressure.The disease was first described and named by the World Health Organization(WHO)in Geneva in 1973.One of the common causes of the disease is congenital heart disease,which is a disease of heart and great vessels caused by many factors at fetal period such as heredity and environment.Congenital heart disease combined with pulmonary arterial hypertension refers to the abnormal increase of pulmonary artery pressure caused by systemic pulmonary shunt congenital heart disease.In the earliest stages of congenital heart disease with pulmonary arterial hypertension,transcatheter closure and surgical correction can be performed,but many patients have lost the chance of surgery.Congenital heart disease with pulmonary arterial hypertension without corrective therapy can be developed into Eisenmenger 's syndmme(ES),with an average life expectancy(32.5 ±16.0)years and a high mortality rate.In the later stage,complications such as embolism,hemorrhage,polycythemia,infection,arrhythmia,sudden death,abnormal liver and kidney function and bone disease can occur and the main causes of death were sudden cardiac death,heart failure and hemoptysis.With the further study of pulmonary arterial hypertension,a series of methods of diagnosis and treatment were found,and the survival rate and quality of life of patients with congenital heart disease combined with pulmonary arterial hypertension were improved.China is a country with high incidence of congenital heart disease merger pulmonary arterial hypertension,the disease is not only a serious harm to patients,but also a huge economic burden.Therefore,more and more researchers are working hard to find a new,effective and convenient method for diagnosis and treatment.Although there are many researches on congenital heart disease and pulmonary arterial hypertension at present,as the disease process and mechanism is too complicated,there are still many mechanisms are not completely clear.It is of great significance to study the process of oxidative stress in the diagnosis and treatment of Congenital heart disease combined with pulmonary arterial hypertension.As an endogenous antioxidant factor,bilirubin has strong reducibility,which can effectively scavenge oxygen free radicals,and direct bilirubin(DBIL)is a type of bilirubin.Therefore,we designed this experiment to investigate the relationship between the level of DBIL and Congenital heart disease combined with pulmonary arterial hypertension.MethodsIn this study,46 patients with CHD merge PAH were selected from a hospital in Changchun,including 12 patients with patent ductus arteriosus,10 patients with ventricular septal defect,24 patients with atrial septal defect.The examination of electrocardiogram,echocardiography,blood routine,blood biochemistry were performed.According to the severity of WHO,the patients were divided into I/II group,III group and IV group;according to the classification of pulmonary artery systolic pressure(s PAP),they were divided into mild,moderate and severe groups;according to the degree of right heart dilatation(RV/LV),they were divided into 4 groups.We used SPSS 21.0 to analysis the difference of the DBIL among all groups,and the correlation between the indicators and the relevant indicators.Results1.There was no significant difference(P>0.05)in age,gender and grade of WHO,right heart dilatation and pulmonary hypertension systolic pressure in each group.2.There was a significant difference(P<0.05)in the level of DBIL,the WHO classification standard and pulmonary artery systolic pressure in each group.3.In the WHO classification,compared level I / II with level IV,?2=10.386,P =0.001;compared level ? with level IV,?2=10.386,P=0.001.In the pulmonary artery systolic blood pressure classification,compared mild with severe,?2=8.685,P=0.003.With the increase of the level,the level of direct bilirubin increased,and the correlation was more significant when the severity of the disease was serious.4.The correlation between s PAP and DBIL was significant(r=0.390,P=0.007);The correlation between RV/LV and DBIL was significant(r=0.323,P=0.028).ConclusionsDBIL was relative to s PAP,heart function and the degree of enlargement.It can be used to evaluate the severity of patients' disease,and has a clinical significance for clinicians to choose the relative treatment.