BNP、hs-cTnI在左向右分流型先天性心脏病合并重症肺炎婴儿心功能评估中的应用  

Application of BNP and hs-cTnI in cadiac function evaluation of infants with left-to-right shunt congenital heart disease complicated with severe pneumonia

作　　者：张小龙[1] 尹丹 郑敏[1] 吴晓云[1] ZHANG Xiaolong;YIN Dan;ZHENG Min;WU Xiaoyun(Department of Cardiology,Children′s Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院心内科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室,重庆400014

出　　处：《国际检验医学杂志》2020年第22期2756-2760,共5页International Journal of Laboratory Medicine

摘　　要：目的探讨血浆脑钠肽(BNP)、超敏肌钙蛋白I(hs-cTnI)在左向右分流型先天性心脏病(CHD)合并重症肺炎婴儿中对心功能评估的应用价值。方法回顾性分析2015年6月至2019年6月在重庆医科大学附属儿童医院确诊的左向右分流型CHD合并重症肺炎婴儿(病例组)的临床资料,其中64例左向右分流型CHD合并重症肺炎及心力衰竭(HF)婴儿纳入HF组,46例左向右分流型CHD合并重症肺炎无HF婴儿纳入无HF组。均于入院24 h内评估心功能,48 h内完善心脏彩超。另选取同期住院的左向右分流型CHD无肺炎及HF婴儿作为对照组。比较血浆BNP、hs-cTnI水平在各组间的差异,探讨其单项及联合检测诊断HF的应用价值。结果HF组BNP、hs-cTnI水平均明显高于无HF组及对照组,差异均有统计学意义(P<0.05);无HF组BNP、hs-cTnI水平与对照组比较,差异无统计学意义(P>0.05),但无HF组BNP、hs-cTnI异常率高于对照组,差异有统计学意义(P<0.05)。HF组BNP、hs-cTnI水平均与左室射血分数(LVEF)、二尖瓣E峰与A峰比值(E/A值)呈负相关(P<0.05)。血浆BNP诊断HF的截断值为115.130 pg/mL,灵敏度为0.806,特异度为0.826;血浆hs-cTnI诊断HF的截断值为0.054μg/L,灵敏度为0.790,特异度为0.764。二者联合检测诊断HF的灵敏度和特异度提高(0.784、0.883)。结论血浆BNP、hs-cTnI测定可对临床上左向右分流型CHD合并重症肺炎婴儿HF的诊断提供及时、简便、有效的生物学参考指标,并且均与心功能密切相关;BNP、hs-cTnI联合应用可提升患儿HF诊断的准确度,利于临床早期、准确识别HF,有利于及时转诊及治疗方案的制订,避免病情延误、加重。Objective To explore the clinical value of plasma brain natriuretic peptide(BNP)and hypersensitive cardiac troponin I(hs-cTnI)in evaluating cardiac function in infants with left-to-right shunt congenital heart disease(CHD)complicated with severe pneumonia.Methods Clinical data of infants with left-to-right shunt CHD complicated with severe pneumonia diagnosed in the Children′s Hospital of Chongqing Medical University from June 2015 to June 2019 were retrospectively analyzed,64 cases with left-to-right shunt CHD complicated with severe pnenmonia and heart failure(HF)in HF group,and 46 cases without HF in non-HF group.Cardiac function was assessed within 24 hours after admission,and echocardiography was examined within 48 hours.Infants with left-to-right shunt CHD without pneumonia and HF were selected as control group.The difference of plasma BNP and hs-cTnI levels among different groups was compared,and their application value in diagnosing heart failure in infants was explored.Results The plasma BNP and hs-cTnI level in HF group were significantly higher than those in non-HF group and control group,and the differences were statistically significant(P<0.05),and there was no significant difference between non-HF group and control group(P>0.05),but the abnormal rates of BNP and cTnI in non-HF group were significantly higher than those in control group,and the differences were statistically significant(P<0.05).In HF group,BNP and hs-cTnI levels negatively correlated with LVEF and E/A ratio(P<0.05).The cut-off value of plasma BNP in the diagnosis of HF was 115.130 pg/mL,the sensitivity was 0.806,and the specificity was 0.826.The cut-off value of plasma hs-cTnI in the diagnosis of HF was 0.054μg/L,the sensitivity was 0.790,and the specificity was 0.764.ROC of BNP combined with hs-cTnI showed that the sensitivity and specificity of combined diagnosis of HF were improved(0.784,0.883).Conclusion The determination of plasma BNP and hs-cTnI could provide timely,effective and simple biological reference indexes for the d

关 键 词：脑钠肽 超敏肌钙蛋白I 先天性心脏病 重症肺炎 心力衰竭 

分 类 号：R725.4[医药卫生—儿科] R725.6[医药卫生—临床医学]