血清生长分化因子-15、心脏型脂肪酸结合蛋白及脑利钠肽水平与肺炎合并心力衰竭患儿预后的关系  

Relationship between serum levels of growth differentiation factor-15, heart-fatty acid-binding protein, brain natriuretic peptide and prognosis in children with pneumonia associated with heart failure

作　　者：李清涛[1] 陈红云[2] 田利远[1] Li Qingtao;Chen Hongyun;Tian Liyuan(Department of Respiratory,Children′s Hospital of Hebei Province,Shijiazhuang 050031,Hebei Province,China;Department of Pediatrics,Nanpi County People′s Hospital,Cangzhou 061500,Hebei Province,China)

机构地区：[1]河北省儿童医院呼吸一科,石家庄050031 [2]南皮县人民医院儿科,河北沧州061500

出　　处：《中华妇幼临床医学杂志（电子版）》2019年第6期688-694,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：2018年度河北省医学科学研究重点课题计划(20180628)~~

摘　　要：目的探讨血清生长分化因子(GDF)-15、心脏型脂肪酸结合蛋白(H-FABP)及脑利钠肽(BNP)水平与肺炎合并心力衰竭(HF)患儿预后的关系。方法选择2016年5月至2018年5月,于河北省儿童医院诊断的80例肺炎合并HF患儿为研究对象,纳入研究组。选择同期于本院进行儿童保健的80例健康儿童为对照,纳入对照组。采用酶联免疫吸附试验(ELISA),检测2组受试儿血清GDF-15、H-FABP、BNP水平和HF标志蛋白心肌肌钙蛋白(cTnI)、肌酸激酶(CK)-MB水平。2组受试儿血清GDF-15、H-FABP、BNP、cTnI、CK-MB水平比较,采用成组t检验。研究组患儿血清GDF-15、H-FABP及BNP水平与HF标志蛋白cTnI、CK-MB的相关性分析,采用Pearson相关性分析。采用Cox比例风险回归模型,分析血清GDF-15、H-FABP、BNP水平与肺炎合并HF患儿预后的关系。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,2组受试儿监护人均签署临床研究知情同意书。2组受试儿性别构成比、出生胎龄、出生体重、年龄等一般临床资料比较,差异均无统计学意义(P>0.05)。结果①研究组患儿血清GDF-15、H-FABP、BNP、cTnI、CK-MB水平,分别为(5.01±0.73)ng/mL、(36.2±6.2)ng/mL、(899.8±300.3)pg/mL、(0.31±0.10)μg/L、(36.2±5.3)U/L,均显著高于对照组的(0.59±0.10)ng/mL、(1.2±0.3)ng/mL、(21.4±4.3)pg/mL、(0.06±0.02)μg/L、(18.4±2.6)U/L,并且2组比较,差异均有统计学意义(t=53.652、50.432、26.164、21.931、26.973,P均<0.001)。②肺炎合并HF患儿血清GDF-15、BNP水平与血清cTnI水平,均呈正相关关系(r=0.340、P=0.002,r=0.285、P=0.010);血清GDF-15、H-FABP水平与血清CK-MB水平,均呈正相关关系(r=0.765、P<0.001,r=0.302、P=0.006)。③Cox比例风险回归模型分析结果显示,血清GDF-15、H-FABP、BNP高表达患儿的不良预后风险,分别是血清GDF-15、H-FABP、BNP低表达患儿的2.319倍(HR=2.319,95%CI:1.306~4.118,P=0.004),1.737倍(HR=1.737,95%CI:1.027~2.937Objective To investigate the relationship between serum levels of growth differentiation factor(GDF)-15,heart-fatty acid-binding protein(H-FABP)and brain natriuretic peptide(BNP)and the prognosis of children with pneumonia associated with heart failure(HF).Methods Eighty children with pneumonia associated with HF diagnosed in Children′s Hospital of Hebei Province from May 2016 to May 2018 were selected as research subjects and were enrolled into study group.And 80 healthy children who received child care in the same hospital during the same period were selected as control and were enrolled into control group.The serum levels of GDF-15,H-FABP,BNP and HF marker proteins cardiac troponin(cTnI)and creatine kinase(CK)-MB of two groups were detected by enzyme-linked immunosorbent assay(ELISA)and compared by independent-samples t test.Pearson correlation analysis was used to analyze the correlation between serum levels of GDF-15,H-FABP,BNP and HF marker protein cTnI and CK-MB.Cox proportional hazard model was used to analyze the relationship between serum levels of GDF-15,H-FABP,BNP and prognosis of children with pneumonia associated with HF.The procedures followed in this study met the requirements of World Association Declaration of Helsinki revised in 2013.The guardians of all research subjects signed clinical research informed consent.There were no statistical differences between two groups in the general clinical data,such as gender composition ratio,birth gestational age,birth age,age and so on.Results①The serum levels of GDF-15,H-FABP,BNP,cTnI and CK-MB in study group were(5.01±0.73)ng/mL,(36.2±6.2)ng/mL,(899.8±300.3)pg/mL,(0.31±0.10)μg/L,and(36.2±5.3)U/L,respectively,which all were statistically higher than those in control group(0.59±0.10)ng/mL,(1.2±0.3)ng/mL,(21.4±4.3)pg/mL,(0.06±0.02)μg/L,(18.4±2.6)U/L,and all the differences were statistically significant(t=53.652,50.432,26.164,21.931,26.973,all P<0.001).②Among children with pneumonia associated with HF,the serum levels of GDF-15 and BNP of

关 键 词：生长分化因子 脂肪酸结合蛋白质类 利钠肽 脑 生物学标记 肺炎合并心力衰竭 心肌肌钙蛋白 肌酸激酶 儿童 

分 类 号：R725[医药卫生—儿科]