[Study on the effect of adrenomedulin and urotensin-II on pulmonary hypertension of patients with congenital heart disease].

Objective: To evaluate the effect and clinical significance of adrenomedulin (ADM) and urotensin-II (UII) on pulmonary hypertension (PH), by detecting their levels of patients with congenital heart disease and pulmonary hypertension.
Methods: 52 patients with congenital heart disease who had left-to-right shunt were selected randomly. 52 patients were divided three groups according to pulmonary artery systolic pressure (PASP): group A was not pulmonary hypertension (PASP < 30 mm Hg, n = 17); group B was mild pulmonary hypertension (PASP30-49 mm Hg, n = 18); group C was moderate and severe pulmonary hypertension (PASP > or = 50 mm Hg, n = 17). The plasma levels of ADM and UII were detected at each period by radioimmunoassay (RIA) method. It was analyzed the changes of their levels within pre-operation, 20 mins and 7 days post-operation and the interrelation between them and PASP.
Results: (1) Following the severity degree of pulmonary hypertension, the plasma levels of ADM increase. There is positive correlation between PAP and plasma level of ADM (pre-operation r = 0.8012, P < 0.01; 20 min post-operation r = 0.6325, P < 0.01; 7 d post-operation r = 0.7126, P < 0.01). (2) Following the severity degree of pulmonary hypertension, the plasma levels of UII don't change obviously. There is no correlation between PAP and plasma level of UII (P > 0.05). (3) The plasma levels of ADM: group A (pre-operation: 33 pg/ml +/- 5 pg/ml, 20 mins post-operation: 29 pg/ml +/- 4 pg/ml, 7 d post-operation: 20 pg/ml +/- 3 pg/ml); group B (pre-operation: 44 pg/ml +/- 8 pg/ml, 20 mins post-operation: 40 pg/ml +/- 6 pg/ml, 7 d post-operation: 34 pg/ml +/- 4 pg/ml); group C (pre-operation: 60 pg/ml +/- 10 pg/ml, 20 mins post-operation: 58 pg/ml +/- 8 pg/ml, 7d post-operation: 38 pg/ml +/- 4 pg/ml). Plasma level of ADM of each group after CPB is lower than that of each group before operation. It is statistical difference only 7 days post-operation (group A q = 5.41, P < 0.01; group B q = 4.76, P < 0.01; group C q = 6.32, P < 0.01). (4) The plasma levels of UII: group A (pre-operation: 2.2 pmol/L +/- 0.5 pmol/L, 20 mins post-operation: 2.2 pmol/L +/- 0.44 pmol/L, 7 d post-operation: 2.2 pmol/L +/- 0.6 pmol/L); group B (pre-operation: 2.7 pmol/L +/- 0.6 pmol/L, 20 mins post-operation: 2.6 pmol/L +/- 0.6 pmol/L, 7 d post-operation: 2.6 pmol/L +/- 0.5 pmol/L); group C (pre-operation: 2.9 pmol/L +/- 0.6 pmol/L, 20 mins post-operation: 2.6 pmol/L +/- 0.7 pmol/L, 7 d post-operation: 2.8 pmol/L +/- 0.4 pmol/L). Compared with that of each group before operation, Plasma level of UII of each group after operation is no obvious difference (P > 0.05).
Conclusion: (1) Following the severity degree of pulmonary hypertension, the plasma levels of ADM increase. ADM plays an important role in the formation of pulmonary hypertension and restructure. (2) Following the severity degree of pulmonary hypertension, the plasma levels of UII don't change obviously. There is no correlation between PAP and plasma level of UII, but UII may be play an important role in the formation of pulmonary hypertension and restructure. (3) Measuring the levels of ADM may be a reliable method to follow the change of pulmonary pressure and worsening of pulmonary hypertension.