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目的探讨左向右分流型先天性心脏病(congenital le to right shunts,CLRS)患儿红细胞的携氧能力及临床意义。方法以兰州大学第二医院儿科住院确诊的CLRS患儿62例为试验组,门诊健康体检儿童40例为对照组,采用酶联免疫法(ELISA)测定其红细胞2,3-DPG的含量,同时检测其动脉血氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、血液酸碱度(pH)和血氧饱和度为50%的氧分压(P50O2),并进行相关性分析。结果试验组红细胞2,3-DPG含量(2.76±0.98μmol/mL)高于对照组,试验组动脉血PaO2、pH、Hb含量均低于对照组,其差异均有统计学意义(P<0.05)。试验组中室间隔缺损患儿的2,3-DPG含量最高,其次为动脉导管未闭患儿,且各类型间差异均有统计学意义(P<0.05)。此外,先天性心脏病患儿红细胞2,3-DPG水平与PaO2水平存在线性关系[2,3-DPG=12.007 8–(0.154 7×PaO2)],P50O2水平与2,3-DPG水平也存在线性关系[P50O2=26.303 6+(1.799 2×2,3-DPG)]。结论 CLRS患儿体内存在低氧现象。红细胞2,3-DPG含量、血气分析及血红蛋白水平变化的检测对进一步了解CLRS病情转归机制,指导临床实践具有重要参考价值。
Objective To investigate the oxygen carrying ability of erythrocytes in children with left to right shunt congenital heart disease (CLRS) and its clinical significance. Methods Sixty-two children with CLRS confirmed by pediatric inpatient department of Lanzhou University were enrolled in this study. Forty outpatients with healthy physical examination were selected as control group. The content of erythrocyte 2,3-DPG was determined by enzyme-linked immunosorbent assay (ELISA) PaO2, PaCO2, pH and P50O2 of 50% oxygen saturation were measured and the correlation analysis was performed. Results The content of erythrocyte 2,3-DPG (2.76 ± 0.98μmol / mL) in the experimental group was higher than that in the control group. The contents of PaO2, pH and Hb in the experimental group were lower than those in the control group (P <0.05 ). The content of 2,3-DPG in children with ventricular septal defect was the highest in the experimental group, followed by those with patent ductus arteriosus, and there were significant differences among the various types (P <0.05). In addition, there was a linear relationship between erythrocyte 2,3-DPG level and PaO2 level in children with congenital heart disease [2,3-DPG = 12.007 8- (0.154 7 × PaO2)], P50O2 level and 2,3-DPG level also existed Linear relationship [P50O2 = 26.303 6+ (1.799 2 × 2,3-DPG)]. Conclusion There is hypoxia in children with CLRS. Detection of erythrocyte 2,3-DPG content, blood gas analysis and hemoglobin level has important reference value for further understanding of the mechanism of CLRS regression and guiding clinical practice.