Endothelin-1 activation in pediatric patients undergoing surgical coarctation of the aorta repair.
Endothelin-1 activation in pediatric patients undergoing surgical coarctation of the aorta repair.
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DOI：
10.4330/wjc.v9.i12.822
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发表时间：
2017-12-26
影响因子：
1.9
通讯作者：
Davidson JA
中科院分区：
文献类型：
--
作者：
Frank BS;Urban TT;Tong S;Cassidy C;Mitchell MB;Nichols CS;Davidson JA
目的：测定缩窄术前后血浆内皮素-1（ET-1）浓度，探讨其与左室构型改变的关系。对24例年龄2天至10岁的主动脉缩窄患者进行手术修复的前瞻性队列研究。年龄< 1个月的患者的子队列被分类为“新生儿”。术前和术后即刻进行超声心动图检查，以评估左心室质量指数和相对室壁厚度（RWT）。在两个时间点评估血浆ET-1水平。评估ET-1水平与心室重构之间的关系。< 1年的患者显示术前ET-1高于术后（2.8 pg/mL vs 1.9 pg/mL，P = 0.02）。相反，> 1年的患者手术前后ET-1浓度无变化（1.1 vs 1.4，NS）。术前，年龄< 1岁的患者的ET-1显著高于年龄较大的儿童（2.8 vs 1.1，P = 0.001）。术后，两个年龄组之间无差异（1.9 vs 1.4，NS）。围术期新生儿ET-1与RWT呈显著正相关（r = 0.92，P = 0.001）。与ET-1浓度较低的患者相比，术前ET-1 > 2 pg/mL的患者表现出更高的LVMI（65.7 g/m2.7 vs 38.5 g/m2.7，P = 0.004）和更高的RWT趋势（45% vs 39%，P = 0.07）。ET-1浓度是显着的变化，在围手术期周围动脉瘤切除术。年龄较大的儿童和婴儿对手术修复有不同的反应，这表明不同的激活机制。
To determine endothelin-1 (ET-1) concentration before and after surgical coarctectomy and evaluate its association with left ventricular geometric change. A prospective, cohort study of 24 patients aged 2 d to 10 years with coarctation of the aorta undergoing surgical repair. A sub-cohort of patients with age < 1 mo was classified as “neonates”. Echocardiograms were performed just prior to surgery and in the immediate post-op period to assess left ventricle mass index and relative wall thickness (RWT). Plasma ET-1 levels were assessed at both time points. Association between ET-1 levels and ventricular remodeling was assessed. Patients < 1 year demonstrated higher pre-op ET-1 than post-op (2.8 pg/mL vs 1.9 pg/mL, P = 0.02). Conversely, patients > 1 year had no change in ET-1 concentration before and after surgery (1.1 vs 1.4, NS). Pre-op, patients < 1 year demonstrated significantly higher ET-1 than older children (2.8 vs 1.1, P = 0.001). Post-op there was no difference between the age groups (1.9 vs 1.4, NS). Neither RWT nor left ventricle mass index (LVMI) varied from pre-op to post-op. The subset of neonates showed a strong positive correlation between pre-op ET-1 and RWT (r = 0.92, P = 0.001). Patients with ET-1 > 2 pg/mL pre-op demonstrated higher LVMI (65.7 g/m2.7 vs 38.5 g/m2.7, P = 0.004) and a trend towards higher RWT (45% vs 39%, P = 0.07) prior to repair than those with lower ET-1 concentration. ET-1 concentration is significantly variable in the peri-operative period surrounding coarctectomy. Older children and infants have different responses to surgical repair suggesting different mechanisms of activation.