肾上腺髓质素和C型利钠肽在小儿慢性心力衰竭诊断中的价值  

Significance of adrenomedullin and C-type natriuretic peptide in diagnosis of chronic heart failure in children

作　　者：段桂琴[1] 安金斗[2] 周建华[2] 

机构地区：[1]郑州大学第三附属医院,河南郑州450003 [2]郑州大学第一附属医院

出　　处：《山东医药》2006年第22期5-7,共3页Shandong Medical Journal

摘　　要：目的探讨肾上腺髓质素(ADM)和C型利钠肽(CNP)在小儿慢性心力衰竭(CHF)诊断中的价值。方法通过检测42例CHF患儿及11例健康儿童血ADM和CNP的浓度,比较各指标对诊断小儿CHF的敏感度、特异度、阳性预测值、阴性预测值、准确性及约登指数。结果1以ADM≥92.65pg/ml、CNP≥116.07pg/ml为阳性标准对诊断小儿CHF的灵敏度为92.9%、76.2%,特异度为81.8%、72.7%,阳性预测值为95.1%、91.4%,阴性预测值为75%、44.4%,准确性为90.3%、75.5%,约登指数为74.7%、48.9%。2血浆ADM和CNP浓度与心功能分级呈正相关(r=0.62,P<0.01;r=0.36,P<0.05)。结论ADM≥92.65pg/ml诊断小儿CHF是一个具有较高灵敏度和中度特异度的指标。[Objective] To evaluate potential use of adrenomedullin （ADM） and C-type natriuretic peptid （CNP） in diagnosis of chronic heart failure. [Methods] measured ADM and CNP concentration of 42 CHF children and 11 healthy children, and compared their sensitivity, specificity, positive predicative values, negative predictive values, accuracy and Youden index for CHF diagnosis. [Result] ①The area under the receiver operating charcteristic （ROC） curve, which determines the diagnostic accuracy of ADM in CHF, was 90. 3 % （P〈0. 01）; the area about CNP was 75.5% （P〈0. 01）. ADM level of 92.65 pg/ml had sensitivity of 92.9%, specificity of 81.8%, positive predictive value of 95.1%, negative predictive of 75% and Youden index of 74. 7% for diagnosing CHF. CNP level of 116.07 pg/ml had sensitivity of 76.2%, specificity of 72.7%, positive predictive of 91.4 %, negative predictive value of 44. 4 % and Youden index of 48.9 % for diagnosing CHF. Both of the indices, ADM had the highest sensitivity, specificity, positive predictive, negative predictive, Youden index and accuracy. ②There was significantly positive correlation between the levels of ADM and the severity of CHF （r=0.62, P〈0. 01）. The severity of CHF was shown to be slightly positively correlated with plasma CNP levels （r= 0. 36, P.〈0. 05）. [Conclusion] ADM≥92. 69 pg/ml is a highly sensitive and moderately specific index for chileren CHF diagnosis.

关 键 词：心力衰竭 慢性 儿童 肾上腺髓质素 利钠肽 C型 

分 类 号：R725.4[医药卫生—儿科]