Change Of Serum Uric Acid And Lactate Dehydrogese And Its Implication In Pulmonary Arterial Hypertension Associated With Adult Congenital Heart Disease

ObjectiveThis study was to investigate the change of the serum uric acid(UA)and lactate dehydrogenase(LDH)levels in pulmonary arterial hypertension associated with congenital heart disease(CHD-PAH)and analyze its correlation with pulmonary artery systolic pressure(PASP),exploring the potential role of UA and LDH in patients with CHD-PAH.Methods151 CHD patients who evaluated with transthoracic echocardiography were included in the Gansu Provincial hospital from September 2017 to December 2019.Patients were divided into four groups according to PASP: CHD with normal pulmonary arterial pressure group(A group,n=29),CHD with mild PAH group(B group,n=38),CHD with moderate PAH group(C group,n=41),CHD with severe PAH group(D group,n=43).30 healthy subjects were included into control group.All patients underwent clinical evaluation,echocardiography,blood routine examination,liver and kidney function,lipid profile,uric acid and lactic acid dehydrogenase.Results1.The levels of serum UA were significantly increased in patients with CHD-PAH compared with CHD patients without PAH and the control subjects(350.5±95.4 vs 286.0±77.0,P<0.05;350.5±95.4 vs 282.2 ±64.2,P<0.05;respectively).2.The levels of serum LDH were significantly increased in patients with CHD-PAH compared with CHD patients without PAH and the control subjects(200.3±55.2 vs 175.1±28.3,P<0.05;200.3±55.2 vs 175.7±29.6,P<0.05;respectively).3.There was statistically significant difference between five groups for UA levels(F=9.650,P<0.05).Multiple comparisons was carried out,the levels of serum UA was significantly increased in CHD patients with severe PAH than in the CHD patients without PAH or the control subjects(390.3±122.6 vs 286.0±77.0,P<0.05;390.3±122.6 vs 282.2±64.2,P<0.05;respectively).Circulating UA levels were significantly increased in the CHD patients with moderate PAH group compared with CHD patients without PAH or the control subjects(329.4 ± 75.1 vs 286.0 ± 77.0,P<0.05;329.4 ± 75.1 vs 282.2 ± 64.2,P<0.05;respectively).The levels of UA was significantly increased in CHD patients with mild PAH than in the CHD patients without PAH or the control subjects(328.2±61.1 vs 286.0±77.0,P<0.05;328.2±61.1 vs 282.2±64.2,P<0.05;respectively).The levels of UA in patients were increased in CHD without PAH compared with the control group,but no statistic difference(286.0±77.0 vs 282.2±64.2,P=0.86).4.There was statistically significant difference between five groups for LDH levels(F=8.212,P<0.05).Multiple comparisons was carried out,the levels of serum LDH was significantly increased in CHD patients with severe PAH than in the CHD patients without PAH or the control subjects(223.6±56.3 vs 175.1±28.3,P<0.05;223.6±56.3 vs 175.7±29.6,P<0.05;respectively).Circulating LDH levels were significantly increased in the CHD patients with moderate PAH group compared with the CHD patients without PAH or the control subjects(197.7±57.6 vs 175.1±28.3,P<0.05;197.7±57.6 vs 175.7±29.6,P<0.05;respectively).The levels of serum LDH was higher in CHD patients with mild PAH than in the CHD patients without PAH or the control subjects(176.8±39.5 vs 175.1±28.3,P=0.88;176.8±39.5 vs 175.7±29.6,P=0.92;respectively),but no statistic difference.5.PASP in the CHD patients were positively correlated with UA and LDH(r=0.405,P<0.05;r=0.400,P<0.05;respectively).6.The positive correlation between UA and LDH was 0.260,the difference was significant.Conclusions1.The levels of serum UA and LDH was significantly increased in CHD-PAH than in the CHD patients without PAH or the control subjects,suggesting that the concentrations of UA and LDH in patients with CHD could provide an objective experimental basis for the early diagnosis of PAH.2.The levels of serum UA and LDH were positively correlated with PASP in patients with CHD,suggesting serum UA and LDH levels may be used as noninvasive indicators to determine pulmonary artery pressure levels of the CHD-PAH.3.There was a positive correlation between serum UA levels and LDH levels in CHD-PAH patients,suggesting that UA and LDH may enteract with each other,contributing to pulmonary vascular remodeling.