The role of B-type natriuretic peptide in critical care of pediatric patients with congenital heart diseases

• Main Authors: Jong-Hau Hsu, 徐仲豪
• Other Authors: Jiunn-Ren Wu
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/26443607286474947033

博士 === 高雄醫學大學 === 醫學研究所 === 102 === Background: B-type natriuretic peptide (BNP) is a 32 amino acid polypeptide hormone, with diuretic, natriuretic and vasoactive properties, which is widely used as a biomarker of congestive heart failure in adults. However, its role in critical care of congenital heart disease (CHD) is not fully elucidated. In addition, its physiologic role in CHD is unknown. Purposes: 1) To investigate the role of BNP in the critical care of pediatric patients with CHD. 2) To determine its anti-remodeling effect on pulmonary vascular system in vitro. Methods: In patients, we prospectively studied the ability of BNP in predicting outcome in several groups of CHD, including: 1) neonates (&;lt;30 days olds undergoing surgery, 2) patients required extracorporeal cardiac life support (ECLS) after surgery, 3) patients undergoing uni-ventricular repair (partial and total cavopulmonary anastomosis) and 4) premature neonates with patent ductus arteriosus (PDA). In vitro, we studied the anti-proliferative and anti-migratory effects of BNP in pulmonary arterial smooth muscle cell (PASMC). Results: In pediatrics patients with CHD, we found perioperative plasma levels of BNP or its increase can predict poor outcomes in neonates undergoing cardiac surgery, children undergoing partial or total cavopulmonary anastomosis, patients receiving ECLS after surgery, and response to indomethacin in premature neonates. In vitro, we found BNP can prevent angiotensin II-induced proliferation and migration in PASMCs, via anti-oxidative, calcium influx and MAPK pathways. These anti-remodeling effects are mediated through cGMP/PKG pathway. Conclusion: BNP is a valuable prognostic biomarker in the critical care of neonates, infants and children with CHD. In addition, BNP can inhibit pulmonary vascular remodeling in vitro and further studies are warranted to elucidate its physiologic role in CHD.