Mediatorii inflamatori: citokinele, oxidul nitric şi endotelina-1 în insuficienţa cardiacă la copil secundară cardiopatiilor congenitale asociate cu hipertensiune pulmonară

Abstract

The purpose of the study was to examine the pathophysiological particularities of cytokines, nitric oxide (NO) and endothelin-1 (ET-1) in chronic heart failure (CHF) resulting from congenital heart diseases (CHD) associated with pulmonary arterial hypertension (PAH). The study group consisted of 86 children with CHF secondary to CHD, in whom were found serum levels of cytokines in sanguine serum: IL-1β, IL-6 and TNF-alpha, NO and ET-1. The first, base, group was of 70 children with CHF and PAH of different levels; the second, for comparison consisted of 16 patients with CHF, but without PAH. The results were compared to a group of 15 healthy children of the same age. High serum values of cytokines were identified in patients with CHF secondary to congenital shunts complicated with PAH compared to those found in the witness group, but were even more evident in those with severe PAH, surpassing the level of children with moderate PAH with CHF (p < 0.05) and without PAH (p <0.05, p = 0.01). In patients with CHF and severe PAH the lesion in the endothelium’s causes an imbalance between the production of the mediators with vasodilator effects and those with vasoconstrictor properties. The NO level was found to be significantly higher in patients with moderate PAH compared to those with severe PAH (p < 0.05), while the ET-1 values were higher in children with severe PAH compared to those with a moderate NO level and without PAH (p < 0.001).

Настоящее исследование включало 86 детей с хронической сердечной недостаточностью (ХСН) на фоне врожденных пороков сердца (ВПС), у которых были определены в сыворотке крови цитокины (IL-1β, IL-6, TNF-alfa), оксид азота и эндотелин-1. Первая, основная группа, составила 70 детей с ХСН и легочной артериальной гипертензией (ЛАГ) различной степени тяжести, вторая группа - 16 детей с ХСН, но без ЛАГ. Уровень цитокинов (IL-1β, IL-6, TNF-alfa), оксида азота и эндотелина-1 были повышены в сыворотке крови у пациентов с ХСН, на фоне ВПС с лево-правым сбросом и ЛАГ, по сравнению с группой здоровых детей. Эти параметры были выше в подгруппе детей с высокой ЛАГ (p < 0,05, p < 0,001), что свидетельствует о более глубоком повреждении эндотелия легочных сосудов.