脑钠肽及氮端脑钠肽对新生儿败血症心肌损伤的诊断价值  

Diagnostic value of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide in myocardial injury of neonatal septicemia

作　　者：董湘玉[1] 惠迎春[1] 沈阳[1] 

机构地区：[1]兰州大学第二医院儿科,730000

出　　处：《中华儿科杂志》2009年第6期462-465,共4页Chinese Journal of Pediatrics

基　　金：甘肃省自然科学基金暨中青年科技基金项目（3ZS061-A25-100）

摘　　要：目的探讨新生儿败血症并发心肌损伤时血浆脑钠肽（brain natriuretic peptide，BNP）和氮端脑钠肽（N—terminal pro—B—type natriuretic peptide，NT—proBNP）在败血症的不同时期血浆水平的变化及在不同胎龄儿中表达水平的差异，为新生儿败血症心肌损伤提供早期诊断的可靠实验室指标。方法将临床诊断新生儿败血症的患儿96例，分为心肌损伤组和非心肌损伤组，发病第2、5、10天采用酶联免疫吸附法分别检测血浆BNP和NT-proBNP的水平，在新生儿败血症并心肌损伤急性期（即入院第5天）将BNP和NT-proBNP血浆水平与肌酸激酶同工酶（creatine kinase isoenzyme，CK-MB）和肌钙蛋白I（troponinI，cTnI）比较，同时分析不同胎龄对血浆脑钠肽和氮端脑钠肽水平的影响。结果BNP值在入院第5天，心肌损伤组和非心肌损伤组比较差异有统计学意义（P〈0．05），其值分别为（215．5±69．6）pmol／L和（119．3±37．4）pmol／L；第2、10天比较差异无统计学意义（P〉0．05），其值分别为（58．7±15．7）pmol／L和（61．7±18．1）pmol／L，（95．1±25．3）pmol／L和（74．5±19．3）pmol／L。NT-proBNP在第2、5、10天两组比较差异均有统计学意义（P〈0．05），以第5天的升高较明显。NT—proBNP值第5天心肌损伤组和非心肌损伤组分别为（315．5±69．7）pmol／L和（179．3±27．5）pmol／L。入院第5天，BNP值两组分别为（215．5±69．6）pmol／L和（119．3±37．4）pmol／L，NT-proBNP值两组分别为（315．5±69．7）pmol／L和（179．3±27．5）pmol／L，cTnI值两组分别为（1．57±0．39）μg／L和（0．55±0．2）μg／L，CK—MB两组间比较差异无统计学意义（P〉0．05）。不同胎龄儿中BNP和NT-proBNP的值以早产儿最高，早产儿BNP值为（159．5±39．6）pmoL／L，NT-proBNP值为（238．5±49．7）pmol／L，三组比较差异有统计学意义（P〈0．05）。结论新生�Objective Neonatal sepsis can cause multiple organ dysfunction syndrome, especially including myocardial injury and heart failure. In this study, the authors observed the changes and the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide in myocardial injury of neonatal sepsis at the different stages to search for the early diagnostic index of myocardial injury and heart failure in patients with neonatal septicemia. Method The levels of plasma brain natriuretic peptide and N- terminal pro-B-type natriuretic peptide were determined in 96 newborns with neonatal septicemia according to the diagnosis and treatment program of neonatal septicemia in 2003. The 96 cases were divided into myocardial injury group and non-myocardial injury group. Every newborn was tested for the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide with enzyme-linked immunosorbent assay （ELISA） on the second day, fifth day and tenth day of septicemia and in the different gestational ageinfants. Meanwhile, the results were compaired to creatine kinase isoenzyme and troponin I. Result The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly different between myocardial injury group and non-myocardial injury group at the fifth day （ P 〈 0. 05 ）, especially the levels of plasma N-terminal pro-B-type natriuretic peptide were significantly elevated at the early stage（ on the second day） between the two groups（P 〈0. 05）. On the fifth day, The values of plasma N-terminal pro-B-type natriuretic peptide were （315.5 ± 69. 7） pmol/L in myocardial injury group, but the value of non-myocardial injury group was （ 179. 3 ± 27. 5 ） pmol/L . On the fifth day, the results of plasma brain natriuretic peptide, N-terminal pro-B-type natriuretic peptide and troponin I were significantly different and had statistical significance between the myocardial injury group and non-myocardial injury group （P 〈 0.

关 键 词：婴儿 新生 脓毒症 重症监护病房 新生儿 心肌损伤 脑钠肽 氮端脑钠肽 

分 类 号：R686[医药卫生—骨科学]