氨基末端脑钠肽前体预测早产儿症状性动脉导管未闭的价值  

Value of amino-terminal pro-brain natriuretic peptide as a predictive marker of symptomatic patent ductus arteriosus in preterm infants

作　　者：卢凯珊 郭小玲[2] 吕峻峰[2] 黄少励 杨春晖[2] 邹志慧[2] 陈志君[2] 赖春华[2] 杨冰岩[2] 

机构地区：[1]南方医科大学第三临床医学院儿科,广东广州510630 [2]南方医科大学附属中山博爱医院儿科,广东中山528403

出　　处：《中国当代儿科杂志》2015年第11期1160-1164,共5页Chinese Journal of Contemporary Pediatrics

基　　金：广东省医学科学技术研究基金项目(B2015084)

摘　　要：目的 探讨氨基末端脑钠肽前体（NT-pro BNP）预测早产儿症状性动脉导管未闭（s PDA）的价值。方法 选择2014年6月至2015年4月出生、胎龄≤32周、48 h内超声心动图确定存在动脉导管的早产儿为研究对象,监测其临床表现,于生后3 d及5 d检测血清NT-pro BNP水平并行超声心动图检查,根据患儿临床表现、超声心动图结果分为s PDA组及非症状性动脉导管未闭（as PDA）组,分析血清NT-pro BNP水平与超声指标的关系,比较两组间相同日龄血清NT-pro BNP水平,ROC曲线确定血清NT-pro BNP水平预测s PDA的敏感性、特异性。结果 共69例早产儿纳入研究,其中s PDA组13例,as PDA组56例。血清NT-pro BNP水平与动脉导管管径、左房内径与主动脉根部内径比值（LA/AO）呈正相关关系（分别r=0.856、0.713,均P〈0.05）;生后3 d、5 d,s PDA组血清NT-pro BNP水平均高于as PDA组,差异有统计学意义（P〈0.05）。生后3 d血清NT-pro BNP水平预测s PDA的ROC曲线下面积为0.949（95%CI：0.892～1.000,P〈0.001）,临界值为27 035 pg/m L,敏感度为92.3%,特异度为94.6%;生后5 d血清NT-pro BNP水平预测s PDA的ROC曲线下面积为0.924（95%CI：0.848～1.000,P〈0.001）,临界值为6 411 pg/m L,敏感度为92.3%,特异度为92.9%。结论 NT-pro BNP可能是动脉导管分流量的量化指标;生后3 d及5 d血清NT-pro BNP水平的检测均有助于早期预测s PDA。Objective To study the value of amino-terminal pro-brain natriuretic peptide（NT-pro BNP） in predicting symptomatic patent ductus arteriosus（s PDA） in preterm infants. Methods Preterm infants born at a gestational age（GA） of ≤32 weeks and diagnosed with patent ductus arteriosus（PDA） by echocardiography within 48 hours after birth between June 2014 and April 2015 were selected as subjects. Their clinical manifestations were observed, and serum NT-pro BNP levels were measured and echocardiography was performed at 3 and 5 days after birth. The infants were divided into s PDA group and asymptomatic PDA（as PDA） group based on their clinical manifestations and the results of echocardiography. The correlations between serum NT-pro BNP level and echocardiographic indices were analyzed. Serum NT-pro BNP levels were compared between the two groups. The receiver operator characteristic（ROC） curve was applied to determine the sensitivity and specificity of serum NT-pro BNP in the prediction of s PDA. Results A total of 69 preterm infants were enrolled in this study, with 13 infants in the s PDA group and 56 infants in the as PDA group. Serum NT-pro BNP level was positively correlated with the diameter of the arterial duct（r=0.856;P〈0.05）and the ratio of left atrial diameter to aortic root diameter（LA/AO）（r=0.713; P〈0.05）. At 3 and 5 days after birth, the serum NT-pro BNP levels in the s PDA group were significantly higher than those in the as PDA group（P〈0.05）. The area under the ROC curve（AUC） for the prediction of s PDA by NT-pro BNP levels at 3 days after birth was 0.949（95% CI： 0.892-1.000; P〈0.001）, with a cut-off value of 27 035 pg/m L（sensitivity： 92.3%; specificity： 94.6%）; the AUC for the prediction of s PDA by NT-pro BNP levels at 5 days after birth was 0.924（95% CI： 0.848-1.000; P〈0.001）, with a cut-off value of 6 411 pg/m L（sensitivity： 92.3%; specificity： 92.9%）. Conclusions NT-pro BNP may be a quantitative index for shunt volume.

关 键 词：动脉导管未闭 氨基末端脑钠肽前体 早产儿 

分 类 号：R722.6[医药卫生—儿科]