血清脑钠素水平对儿童肺炎心力衰竭诊断价值的研究  

Value of Serum Brain Natriuretic Peptide Change in Diagnosing Children's Pneumonia Complicated by Heart Failure

作　　者：徐强[1] 周晓聪[1] 张园海[1] 褚茂平[1] 

机构地区：[1]温州医学院附属育英儿童医院心内科,浙江省温州市325003

出　　处：《中国全科医学》2009年第21期1947-1949,共3页Chinese General Practice

摘　　要：目的探讨血清脑钠素水平对儿童肺炎心力衰竭的诊断价值。方法将65例肺炎伴有呼吸困难的患儿分为3组:轻型肺炎组(20例),重症肺炎无器质性心脏病组(20例)和重症肺炎合并器质性心脏病组(25例)。同期门诊健康体检儿童15例作为对照组。采用酶联免疫吸附法测定血清脑钠素水平,同时测定血肌钙蛋白I水平,超声心动图检测左室射血分数(LVEF)。结果4组对象的脑钠素水平间差别有统计学意义(P<0.05)。重症肺炎合并器质性心脏病组脑钠素水平与对照组、轻型肺炎组和重症肺炎无器质性心脏病组比较,差别均有统计学意义(x^((2))值分别为22.18、25.39和12.29,P<0.05)。重症肺炎合并器质性心脏病组血肌钙蛋白I水平与对照组、轻型肺炎组和重症肺炎无器质性心脏病组比较,差别均有统计学意义(x^((2))值分别为11.39、19.90和13.38,P<0.05)。重症肺炎无器质性心脏病组与轻型肺炎组、对照组比较,血肌钙蛋白I水平和LVEF间差异无统计学意义(P>0.05)。脑钠素对心源性呼吸困难鉴别诊断的运动员作业特征(ROC)曲线下面积为0.858(P<0.05),各项诊断指标均明显优于血肌钙蛋白I、LVEF。结论血清脑钠素水平可反映肺炎患儿心功能变化,重症肺炎无心脏病患儿虽有呼吸困难,但心功能尚在代偿范围之内,LVEF无明显下降,血肌钙蛋白I呈阴性;血清脑钠素诊断价值优于血肌钙蛋白I、IVEF,为判断儿童肺炎心力衰竭客观而可靠的指标。Objective To study the diagnostic value of serum brain natriuretic peptide （BNP） in children with pneumonia complicated by heart failure.Methods A total of 65 pneumonia children with accompanying dyspnea were divided into 3 groups： 20 in mild pneumonia （mild） group, 20 in severe pneumonia with no organic heart complication （severe） group and 25 in severe pneumonia complicated by organic heart disease （complication） group. Enzyme linked immunosorbent assay was used to measure BNP level and the concentration of cTn I, and left ventricular ejection fraction （LVEF） was also evaluated by echocardiography.Results There was a significant difference in serum BNP concentration among the 4 groups （P〈0.05）. The serum BNP level in the complicated group was significantly higher than those in the control, mild and sever groups, with a significant difference （X^2=22.18, 25.39, 12.29, respectively,P〈0.05）. And the serum cTn I level in th4e complication group was significantly different from those in the control, mild and sever groups（X^2=11.39, 19.90, 13.38, respectively, P〈0.05）. There was no significant difference in both cTn I level and LVEF among the control, mild and sever groups （P〉0.05）. The area under receiver operating characteristic （ROC） curve, or BNP differential diagnosis value to cardiac dyspnea subjects, was 0.858 （P〈0.05）, in which every item of diagnosis was better than cTnI level and LVEF. Conclusion Serum BNP concentrate can reflect heart function in children with pneumonia. The children with severe pneumonia without heart complication have symptom of dyspnea, but their cardiac function is still in the scope of compensation, LVEF is of no obvious decrease, cTn I is negative. The diagnostic value of BNP is better than those of cTn I and LVEF, and it is an objective and reliable index to identify cardiac failure in children.

关 键 词：肺炎 心力衰竭 利钠肽 脑 

分 类 号：R725.631[医药卫生—儿科]