目的探讨不同类型左向右分流先天性心脏病(CHD)患儿血肌钙蛋白Ⅰ(cTnⅠ)的变化。方法入选146例继发孔型房间隔缺损(ASD)、132例室间隔缺损(VSD)患儿,300例健康对照儿童,测定血cTnⅠ及脑利钠肽前体(NT-proBNP)水平,并分析其与患儿临床情况的相关性。结果 ASD组、VSD组以及对照组之间的血清cTnⅠ和NT-proBNP水平的差异均有统计学意义(H=3.89、5.27,P<0.01),VSD组患儿血清cTnⅠ和NT-proBNP水平均高于ASD组,差异有统计学意义(P均<0.05)。VSD组的肺循环/体循环压力比(Pp/Ps)、肺血管阻力指数(PVRI)以及标准化左心室舒张末期容积高于ASD组,差异有统计学意义(P均<0.05)。多元回归分析显示,在VSD患儿中Pp/Ps对cTnⅠ水平有显著影响(β=0.81,SE=0.03,P=0.000)。结论左向右分流型CHD所引起的心脏容量与压力变化可引起心肌损伤并最终导致不可逆性的心肌重塑。cTnⅠ可用于评估VSD所引起的不同程度心肌损伤。 Objective To investigate the changes of cardiac troponin Ⅰ (cTn Ⅰ) in children with different types of left-sided shunt with congenital heart disease (CHD). Methods One hundred and sixty-six children with ASD, 132 children with ventricular septal defect (VSD) and 300 healthy controls were enrolled in this study. The levels of cTnI and NT-proBNP in blood were measured, Analysis of its correlation with the clinical situation in children. Results The serum levels of cTnⅠ and NT-proBNP in ASD group, VSD group and control group were all significantly different (H = 3.89,5.27, P <0.01). The levels of serum cTnⅠand NT-proBNP in children with VSD Compared with ASD group, the difference was statistically significant (all P <0.05). The volume of pulmonary artery / systemic pressure (Pp / Ps), pulmonary vascular resistance index (PVRI) and normalized left ventricular end-diastolic volume in VSD group were significantly higher than those in ASD group (all P <0.05). Multiple regression analysis showed that Pp / Ps had a significant effect on cTnI in children with VSD (β = 0.81, SE = 0.03, P = 0.000). CONCLUSIONS: Changes in heart volume and pressure caused by left-to-right shunt CHD can cause myocardial damage and ultimately lead to irreversible myocardial remodeling. cTnI can be used to assess different degrees of myocardial injury caused by VSD.