N末端脑钠肽前体对早产儿呼吸窘迫综合征并发心力衰竭的评估价值  

Value of N4erminal pro-brain natriuretic peptide on evaluating heart failure in neonates with respiratory distress syndrome

作　　者：张茜[1] 时赞扬[1] 罗成汉[1] 程欣茹[1] 张珊珊[1] 王丽[1] 郭宏湘[1] 张勤[1] 徐千雅[1] 程秀永[1] 盛光耀[1] 

机构地区：[1]郑州大学第一附属医院儿科,450052

出　　处：《中华实用儿科临床杂志》2013年第1期19-23,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省医学科技攻关计划项目（201202003）

摘　　要：目的探讨血浆氨基末端脑钠肽前体（NT—proBNP）水平对早产儿呼吸窘迫综合征（RDS）并发心力衰竭（HF）的诊断或排除价值。方法选择2011年1月至2012年10月郑州大学第一附属医院NICU收治的RDS患儿115例，分为HF组（56例）和无HF组（59例）。对2组患儿出生24h内心脏生化标志物及床旁超声心动图心功能指标进行单因素分析，采用Logistic回归模型评估诊断HF的独立指标，并采用受试者工作特征曲线（ROC）下面积（AUC）找出诊断HF的敏感度及特异度90％以上的界值。结果对2组RDS患儿的心脏生化标志物及超声心动图心功能指标单因素分析发现，cTnI、CK-MB水平差异均无统计学意义（P均〉0．05）。HF组患儿出生24h内PDA、卵圆孔未闭以及肺动脉高压合并症发生率、血浆NT-proBNP、肺动脉收缩压力水平均高于无HF组患儿（P均〈0．05），左心室射血分数、二尖瓣E／A比值均低于无HF组患儿（P均〈0．05）；提示这7个因素可能与早产儿RDS合并HF有关，将上述相关因素进一步行Logistic回归模型强行进入分析，只有血浆NT—proBNP水平是HF的独立危险因素（OR=1．359，P=0．000）。以血浆NT—proBNP水平描绘诊断HFROC，AUC为0．997，AUC95％CI：0．962—1．000，P=0．000，NT—proBNP在16379ng／L水平时，诊断HF敏感度为91．1％，特异度为98．3％。8例死亡组患儿于24h时及最终血浆NT—proBNP水平均为35000ng／L，显著高于同期存活患儿水平（P=0．000）。结论血浆NT—proBNP水平具有诊断或排除RDS早产儿HF并发症的价值，且动态观察HF患儿血浆NT—proBNP水平可早期预测死亡风险。Objective To explore the value of plasma N-terminal pro-brain natriuretic peptide（NT-proBNP） in diagnosing or excluding concurrent heart failure （HF） in neonates with respiratory distress syndrome （RDS）. Methods One hundred and fifteen preterm infants with RDS, admitted to Neonatal Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from Jan. 2011 to Oct. 2012 ,were classified into 2 groups：HF group （56 cases） and non-HF group （59 cases）. Differences in cardiac biomarkers and parameters of ultrasonic cardiogram for cardiac function between the 2 groups were analyzed within 24 hours after birth through univariate factors. To evaluate independent factors for HF, logistic regression analysis was performed including significant univariate factors. Receiver operator characteristic curve （ROC） was used to determine the best cutoff for diagnosis of HF with sensitivity and specificity of more than 90%. Resalts The level of plasma troponin and CK-MB showed no significant difference between the 2 groups （ all P 〉 0.05 ）. Compared with the non-HF group, the incidence of patent ductus arteriosus, patent foramen ovale and pulmonary hypertension, as well as plasma NT-proBNP level and pulmonary artery pressure were significantly higher in the HF group（all P 〈 0.05）. In contrast, left ventricular ejection fraction and E/A ratio were significantly lower in the HF group （all P 〈 0. 05 ）. Logistic regression analysis, which was performed using the 7 significant univariate factors, showed that only plasma NT-proBNP was the independent factor for evaluating HF（ OR = 1. 359 ,P =0. 000）. The area under ROC for NT-proBNP levels for diagnosis of HF in RDS neonates was 0.997 （95% CI 0.962 - 1.000,P =0.000）. A cutoff value of at least 16 379 ng/L had a sensitivity of 91.1% and specificity of 98.3%. All the 8 neonates who died had a plasma NT-proBNP level of 35 000 ng/L in 24 hours after birth, significantly higher than that in survival neonates（ P = 0.000）. Co

关 键 词：呼吸窘迫综合征 N末端脑钠肽前体 心力衰竭 诊断 

分 类 号：R722[医药卫生—儿科]