N末端脑钠肽前体联合床边心脏超声对新生儿脓毒症心功能障碍的预测价值  

Predictive value of N-terminal pro-brain natriuretic peptide combined with bedside echocardiography in neonatal sepsis with cardiac dysfunction

作　　者：杨春燕[1] 秦道刚[1] 韩梅盈 刘风敏 李宝云[1] 许平[1] 杨巧芝[1] Yang Chunyan;Qin Daogang;Han Meiying;Liu Fengmin;Li Baoyun;Xu Ping;Yang Qiaozhi(Neonatal Intensive Care Unit,Liaocheng People′s Hospital,Liaocheng 252000,Shandong Province,China)

机构地区：[1]聊城市人民医院新生儿重症监护室,山东聊城252000

出　　处：《中华实用儿科临床杂志》2020年第23期1786-1789,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：山东省医药卫生科技发展计划项目(2017WS218);山东省重点研发计划项目(2018GSF118173);聊城市人民医院院级青年科研基金资助项目(2019033)。

摘　　要：目的探讨血清N末端脑钠肽前体(NT-proBNP)联合床边心脏超声在新生儿脓毒症心功能障碍中的诊治价值。方法回顾性分析2016年7月至2017年7月聊城市人民医院新生儿重症监护室病房收治并诊断为新生儿脓毒血症的56例患儿(脓毒症组),将其分为心功能障碍组(26例)和无心功能障碍组(30例),同期住院一般感染患儿为对照组(45例)。比较各组患儿临床特征、相关实验室指标及预后,多因素Logistic回归分析影响新生儿脓毒性新功能障碍的相关因素,采用受试者工作特征曲线(ROC)分析相关指标对新生儿脓毒症心功能障碍的早期预测价值。结果心功能障碍组患儿发病年龄[63.0 h(30.5 h,185.6 h)]早于无心功能障碍组[65.0 h(34.5 h,170.6 h)]和对照组[80.0 h(45.5 h,202.3 h)],差异有统计学意义(P<0.05);3组原发病的感染部位比较差异无统计学意义(P>0.05),且均以肺部感染为主;心功能障碍组NT-proBNP水平[20230.6 ng/L(15890 ng/L,35000 ng/L)]、超敏C反应蛋白(hs-CRP)/清蛋白(ALB)[0.33(0.29,0.81)]较对照组[7324.5 ng/L(2426.5 ng/L,13890.0 ng/L)、0.06(0,0.21)]明显升高,差异均有统计学意义(均P<0.05)。心功能障碍组右心室内径为(8.74±2.42)mm,Tei指数为0.52±0.03,均明显高于对照组[(8.55±1.41)mm、0.30±0.04],而EF仅(62.61±2.56)%,明显低于对照组[(70.03±0.35)%],2组比较差异均有统计学意义(均P<0.05);ROC曲线分析结果显示,NT-proBNP、Tei指数对脓毒症心功能障碍均有较好的预测价值,其中,NT-proBNP以12291.5 ng/L为截点值,敏感度和特异度分别为80%和79%,曲线下面积(AUC)为0.81;Tei指数以0.45为截点值,敏感度和特异度分别为74%和77%,AUC为0.78。结论NT-proBNP可作为新生儿脓毒症早期心功能障碍的标志物之一,结合床边超声心动图Tei指数,可快速诊断脓毒症患儿的心功能障碍,更好地指导临床医师用药,改善心功能,提高治疗效果。Objective To investigate the value of N-terminal pro-brain natriuretic peptide(NT-proBNP)combined with bedside echocardiography in diagnosis and treatment of neonatal sepsis with cardiac dysfunction.Methods A total of 56 children diagnosed with neonatal sepsis in the Neonatal Intensive Care Unit,Liaocheng People′s Hospital from July 2016 to July 2017 were enrolled and divided into 2 groups,namely,the cardiac dysfunction group(26 cases)and the non-cardiac dysfunction group(30 cases).Children with general infection(45 cases)hospita-lized at the same period were taken as the control group.The clinical characteristics,related laboratory indexes and prognosis were compared among 3 groups.The related factors of neonatal sepsis with cardiac dysfunction were analyzed by the multivariate Logistic regression approach,and the value of related indexes in the early prediction neonatal sepsis with cardiac dysfunction was analyzed by using the receiver operating characteristic curve(ROC).Results The onset age of sepsis patients with cardiac dysfunction[63.0 h(30.5 h,185.6 h)]was significantly earlier than that of the patients without cardiac dysfunction[65.0 h(34.5 h,170.6 h)]and the control group[80.0 h(45.5 h,202.3 h)](P<0.05).The main primary site of the disease was the lung,which was not statistically significant among the 3 groups(P>0.05).The NT-proBNP level and the high sensitivity-C-reactive protein(hs-CRP)/albumin(ALB)ratio in the cardiac dysfunction group[20230.6 ng/L(15890.0 ng/L,35000.0 ng/L);0.33(0.29,0.81)]were significantly higher than those in the control group[7324.5 ng/L(2426.5ng/L,13890.0 ng/L);0.06(0,0.21)](all P<0.05).The right ventricular diameter and the Tei index of the cardiac dysfunction group[(8.74±2.42)mm;0.52±0.03]were significantly higher than those in the control group[(8.55±1.41)mm;0.30±0.04],while the EF of the cardiac dysfunction group[(62.61±2.56)%]was significantly lower than that in the control group[(70.03±0.35)%](all P<0.05).The ROC curve analysis showed that NT-proBNP and the Tei i

关 键 词：婴儿 新生 脑利钠肽 脓毒症 心功能障碍 超声心动图描记术 

分 类 号：R722.1[医药卫生—儿科]