氨基末端脑钠肽前体对重症手足口病患儿病情及预后评估的意义  

Significance of N-terminal pro-B-type natriuretic peptide in evaluating complications and prognosis of patients with severe hand-foot-and-mouth disease

作　　者：卢秀兰[1] 左超[2] 仇君[1] 刘萍萍[1] 黄娇甜[1] 胥志跃[1] 肖政辉[1] 祝益民[3] 

机构地区：[1]湖南省儿童医院急救中心,长沙410007 [2] 南华大学儿科学院 [3] 湖南省人民医院儿童医学中心

出　　处：《中华实用儿科临床杂志》2015年第10期750-753,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：“十二五”国家科技支撑计划项目（2012BA104801）;湖南省科技计划项目（2013SK3218）

摘　　要：目的 探讨氨基末端脑钠肽前体（NT-proBNP）对重症手足口病患儿病情及预后评估的意义.方法 选择2012年1月至2013年12月在湖南省儿童医院重症监护病房住院的重症手足口病患儿,入院时检测血清NT-proBNP水平,比较发生脑干脑炎、肺水肿、肺出血和循环衰竭并发症及死亡患儿NT-proBNP水平的差异,作出NT-proBNP水平对诊断各类并发症的受试者工作特征（ROC）曲线.结果 脑干脑炎组血清NT-proBNP均值为4 966.71 ng/L,非脑干脑炎组为407.12 ng/L;肺水肿组NT-proBNP均值为7 043.42 ng/L,无肺水肿组为484.52 ng/L;肺出血组NT-proBNP均值为7 828.03 ng/L,无肺出血组为605.18 ng/L;循环衰竭组其NT-proBNP均值为8 325.55 ng/L,无循环衰竭组为602.23 ng/L;死亡组NT-proBNP均值为9 042.60 ng/L,存活组为686.54 ng/L.发生并发症或死亡组患儿Lg （NT-proBNP）水平与无并发症或存活组比较差异有统计学意义（P＜0.05）;NT-proBNP水平与脑干脑炎、肺水肿、肺出血、循环衰竭预后的ROC曲线下面积分别为0.72、0.85、0.89、0.92和0.91,在临界值为550 ng/L时,对预测发生肺水肿、肺出血、循环衰竭和死亡具有较高的敏感度和特异度.结论 重症手足口病患儿血清NT-proBNP水平越高,提示病情越重;入院血清NT-proBNP水平对严重并发症和不良预后具有很好的预测作用;入院血清NT-proBNP＞ 550 ng/L的重症手足口病患儿可能发生肺水肿、肺出血和循环衰竭严重并发症,甚至死亡.Obgective To investigate the value of N-terminal pro-B-type natriuretic peptide （NT-proBNP） in evaluating the complications and prognosis of children with severe hand-foot-and-mouth disease （HFMD）.Methods The children with severe HFMD treated in the Intensive Care Unit of Hunan Provincial Children＆#39;s Hospital from January of 2012 to December of 2013 were recruited and the levels of serum NT-proBNP were detected on admission.Compared with the difference of NT-proBNP between patients with or without brainstem encephalitis,pulmonary edema,pneumorrhagia and the dead cases were compared.The receiver operating characteristic （ROC） curve of NT-proBNP was made.Results The average value of NT-proBNP in brainstem encephalitis was 4 966.71 ng/L,and that without brainstem encephalitis was 407.12 ng/L.The average value of NT-proBNP in pulmonary edema was 7 043.42 ng/L,and that without pulmonary edema was 484.52 ng/L.The average value of NT-proBNP in pneumorrhagia was 7 828.03 ng/L,and that without pneumorrhagia was 605.18 ng/L,the average value of NT-proBNP in circulatory failure was 8 325.55 ng/L,and that without circulatory failure was 602.23 ng/L.The average value of NT-proBNP in the dead cases was 9 042.60 ng/L,and the average value of survivors was 686.54 ng/L.There were significant differences in the levels of Lg（NT-proBNP） between the groups with complications or death and the group without complications or survivals（P 〈 0.05）.The levels of serum NT-proBNP and the area under prognostic ROC curve of brainstem encephalitis,pulmonary edema,pneumorrhagia,circulatory failure,and death respectively was 0.72,0.85,0.89,0.92 and 0.91,respectively.Its sensitivity and specificity were both high if used for forecasting different complications and prognosis by the critical value of 550 ng/L.Conclusions The condition of HFMD was more serious with higher level of NT-proBNP.The level of NT-proBNP is valuable for predicting the prognosis.The level of NT-proBNP higher than 550 ng/L is a signal of patients who

关 键 词：重症手足口病 氨基末端脑钠肽前体 肺水肿 预后 

分 类 号：R725.1[医药卫生—儿科]