氮端B型利钠肽原在极低出生体质量儿血流动力学改变显著的动脉导管未闭诊治中的预测价值  

Predictive value of N-terminal pro-B-type natriuretic peptide in diagnosis and treatment of hemodynamic significant patent ductus arteriosus in very low birth weight infants

作　　者：刘颖[1] 黄珍砾[1] 宫琳[1] 张双船[1] 周于新[1] LIU Ying;HUANG Zhen-Li;GONG Lin(Department of Pediatrics,Shenzhen Hospital,Peking University,Shenzhen,Guangdong 518036,China)

机构地区：[1]北京大学深圳医院儿科,广东深圳518036

出　　处：《中国妇幼保健》2020年第24期4748-4752,共5页Maternal and Child Health Care of China

基　　金：吴阶平医学基金会(编号:320.6750.16036)。

摘　　要：目的探讨氮端B型利钠肽原(NT-proBNP)在极低出生体质量儿(VLBWIs)血流动力学改变显著的动脉导管未闭(hsPDA)诊治中的预测价值,为临床诊治提供参考依据。方法选取北京大学深圳医院新生儿重症监护室2015年1月-2017年9月的VLBWIs 118例,根据心脏彩超和临床症状分为hsPDA组和对照组,hsPDA组患儿给予布洛芬口服治疗。分别检测并比较其生后第1天、第3天的血清NT-proBNP水平。应用受试者操作特性(ROC)曲线来确定NT-proBNP诊断hsPDA和布洛芬治疗无效的临界值。结果91例VLBWIs纳入研究,hsPDA组34例,胎龄(30.1±1.7)周,出生体质量(1.24±0.2)kg,对照组57例,胎龄(30.8±1.3)周,出生体质量(1.30±0.2)kg。生后第1天两组NT-proBNP差异无统计学意义[(1951.8±600.0)pmol/L vs.(1717.5±435.2)pmol/L,t=2.151,P>0.05];第3天,hsPDA组NT-proBNP明显高于对照组,差异有统计学意义[(5686.6±2123.5)pmol/L vs.(1663.6±784.6)pmol/L,t=12.94,P<0.05],生后第3天诊断hsPDA的受试者操作特性(ROC)曲线下面积(AUC)为0.962(95%CI:0.767~1.000;P=0.000)。最适临界值(cut-off值)为2779 pmol/L,灵敏度91.2%,特异度82.5%。hsPDA患儿经过两个疗程的布洛芬治疗,5例无效(14.7%,5/34),其生后第3天的NT-proBNP为(8458.8±618.9)pmol/L,明显高于治疗有效组(5215.9±2129.5)pmol/L,差异有统计学意义(t=4.416,P<0.01)。以7217 pmol/L[灵敏度80.0%,特异度82.8%,AUC:0.890(95%CI:0.928~0.997;P=0.006)]为阈值,可预测药物治疗疗效不佳。结论生后早期的血清NT-proBNP水平是诊断早产儿hsPDA以及指导治疗的良好指标。Objective To explore the predictive value of N-terminal pro-B-type natriuretic peptide in diagnosis and treatment of hemodynamic significant patent ductus arteriosus(hs PDA)in very low birth weight infants,provide a reference basis for clinical diagnosis and treatment.Methods From January 2015 to September 2017,118 very low birth weight infants were selected from Neonatal Intensive Care Unit in Shenzhen Hospital,then they were divided into hs PDA group and control group,the infants in hs PDA group were given oral administration of ibuprofen,the levels of serum NT-pro BNP on the first day and the third day after birth were detected and compared.ROC curve was used to confirm the critical values of NT-pro BNP in diagnosis of hs PDA and ineffective treatment of ibuprofen.Results A total of91 very low birth weight infants were enrolled into this study,including 34 very low birth weight infants in hs PDA group and 57 very low birth weight infants in control group,fetal age and birth weight in hs PDA group were(30.1±1.7)weeks and(1.24±0.2)kg,respectively,fetal age and birth weight in control group were(30.8±1.3)weeks and(1.30±0.2)kg,respectively.On the first day after birth,there was no statistically significant difference in the level of serum NT-pro BNP between the two groups[(1951.8±600.0)pmol/L vs.(1717.5±435.2)pmol/L,t=2.151,P>0.05].On the third day after birth,the level of serum NT-pro BNP in hs PDA group was statistically significantly higher than that in control group[(5686.6±2123.5)pmol/L vs.(1663.6±784.6)pmol/L,t=12.94,P<0.05].On the third day after birth,the area under ROC curve of hs PDA was 0.962(95%CI:0.767-1.000,P=0.000),the optimal cut-off value was2779 pmol/L,the sensitivity and specificity were 91.2%and 82.5%,respectively.After two courses of treatment,ibuprofen was ineffective in 5 infants(14.7%)in hs PDA group,the level of serum NT-pro BNP on the third day after birth was(8458.8±618.9)pmol/L,which was statistically significantly higher than that in effective group[(5215.9±2129.5)pmol/L](t=4

关 键 词：氮端B型利钠肽原 动脉导管未闭 布洛芬 早产儿 极低出生体质量儿 

分 类 号：R722[医药卫生—儿科]