N末端脑钠肽前体联合新生儿危重病例评分预测极低出生体质量儿死亡风险  

The value of N-terminal pro-brain natriuretic peptide combined with neonatal critical illness scores on mortali- ty risk evaluation in very low birth weight infants

作　　者：张茜[1] 时赞扬[1] 王丽[1] 徐淑玲[2] 张珊珊[1] 张勤[1] 盛光耀[1] 

机构地区：[1]郑州大学第一附属医院儿科,450052 [2]郑州市妇幼保健院儿科

出　　处：《中华实用儿科临床杂志》2013年第14期1065-1068,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨N末端脑钠肽前体（NT－proBNP）联合新生儿危重病例评分（NCIS）对极低出生体质量儿（VLBWI）死亡风险的评估价值。方法对2011年6月至2012年12月出生6h内入住郑州大学第一附属医院NICU且出生体质量〈1500g的早产儿，采用NCIS评估VLBWI的死亡风险，同时监测血浆NT—proBNP水平，对影响生存与死亡结局的因素，进行Logistic（强迫进入法），将与死亡密切相关的影响因素，描绘受试者工作特征曲线（ROC），并比较预测死亡风险的ROC曲线下面积（AUC）的特异度及敏感度，并应用重新分类的净改善（NRI）校准NT—proBNP联合NCIS对NCIS评分预测死亡风险的增效价值。结果122例VLBWI中男／女为64／58例，总病死率为17．21％（21／122例）；病死患儿NT—proBNP、pH、动脉血氧分压[Pa（O2）]、尿素氮（BUN）、红细胞比容（HCT）、收缩压、胃肠道损伤、气管插管率以及NCIS评分与存活患儿比较差异均有统计学意义（P均〈0．001），呼吸频率、心率等因素无明显差异（P均〉0．05）。对上述影响因素进行Logistic分析，只有NT—proBNP与死亡密切相关（0R=1．174，P〈0．05）。NT．proBNPAUC为0．935，以〉19580ng／L为检测指标时，敏感度为95．21％，特异度为87．13％；NCIS评分AUC为0．816，分值≤76时，敏感度为95．19％，特异度为56．41％。NT—proBNP＋NCIS评分AUC为0．947，敏感度为100．00％，特异度为84．18％。应用重新分类的有效效应进行校准，NT—proBNP联合NCIS明显提高了NCIS预测 VLBWI的死亡概率（NRI=0．385，Z=2．714，P=0．007）。结论NT—proBNP联合NCIS评分能够早期、准确地预测VLBWI死亡风险，较NCIS评分系统的预测价值明显提高。Objective To explore the value of plasma N-terminal pro-brain natriuretic peptide（NT-proBNP） level combined with the Neonatal critical illness scores（NCIS） on mortality risk evaluation in very low birth weight in- fants （VLBWI）. Methods Between Jun. 2011 and Dec. 2012, preterm infants admitted to the Neonatal Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University within 6 hours after birth ,with birth weight 〈 1500 g were eligible. All the infants were scored with the use of NCIS, and plasma NT-proBNP levels were measured simultaneously. A Logistic regression analysis（ Method = Enter） was performed to determine the independent risk factors. The value of relevant factors on mortality risk evaluation were determined and compared with the use of receiver operator characteris- tic（ROC） curve. The extent to which NT-proBNP reassigned individuals to risk categories that better predicted the mor- tality risk was assessed by use of the net reclassification index（NRI） measure. Results One hundred and twenty-two cases of VLBWI（ male/female = 64/58 cases ） were included in the study. The total mortality rate was 17.21% （21/122 cases）. The NT-proBNP, NCIS score, pH ,Pa （ O2 ）, blood urea nitrogen （ BUN ）, hematocrit （ HCT）, systolic blood pres- sure, occurrence of gastrointestinal injury and occurrence of intubation among those neonates who died was significantly different with those who didn＇t（ all P 〈0. 001 ）. The Logistic regression analysis indicated that NT-proBNP was the only independent factor which was closely related with mortality risk（ OR = 1. 174 ,P 〈 0.05 ）. The area under the ROC curve for NT-proBNP was 0.935 ,with the cut-off 〉 19 580 ng/L,the sensitivity was 95.21% ,the specificity was 87.13%. The area under the ROC curve for NCIS was 0.816,with the cut-off ≤ 76,the sensitivity was 95.19% ,the specificity was 56.41%. The area under the ROC curve for NT-proBNP along with NCIS was 0.947 ,the sensitivity was 100.00%, the specif

关 键 词：极低出生体质量儿 N末端脑钠肽前体 新生儿危重症病例评分 预测 联合 死亡风险 

分 类 号：R722.1[医药卫生—儿科]