先天性心脏病合并肺动脉高压患儿血清H-FABP、NT-proBNP、cTnI变化及临床意义  

Changes and Clinical Significance of Serum H-FABP, NT-proBNP and cTnI in Children with Congenital Heart Disease Complicated with Pulmonary Hypertension

作　　者：汪志新 刘涛 陈彩艳[2] WANG Zhi-xin;LIU Tao;CHEN Cai-yan(Department of Vasculocardiology,Wuhan Red Cross Hospital,Wuhan 430000,China;Department of Obstetrics and Gynecology,Huazhong University of Science and Technology Hospital,Wuhan 430074,China)

机构地区：[1]武汉市红十字会医院心血管内科,武汉430000 [2]华中科技大学医院妇产科,武汉430074

出　　处：《临床误诊误治》2022年第9期90-96,共7页Clinical Misdiagnosis & Mistherapy

基　　金：湖北省卫生和计划生育委员会科研课题(WJ2018H0120)。

摘　　要：目的探讨先天性心脏病(CHD)合并肺动脉高压(PH)患儿血清心脏型脂肪酸结合蛋白(H-FABP)、氨基末端B型脑钠肽前体(NT-proBNP)、肌钙蛋白I(cTnI)变化及临床意义。方法选取2017年12月—2020年12月收治的CHD患儿89例,根据是否合并PH将其分为CHD合并PH组(68例)和单纯CHD组(21例);另选取同期健康体检儿23例作为健康对照组。比较上述3组及不同心功能分级CHD患儿血清H-FABP、NT-proBNP、cTnI水平,不同疾病严重程度CHD合并PH患儿血清H-FABP、NT-proBNP、cTnI水平和心功能指标;分析CHD合并PH患儿血清H-FABP、NT-proBNP、cTnI水平和心功能分级与疾病严重程度的相关性,以及血清H-FABP、NT-proBNP、cTnI水平与心功能指标的相关性。结果血清H-FABP、NT-proBNP、cTnI水平,CHD合并PH组和单纯CHD组均高于健康对照组,CHD合并PH组均高于单纯CHD组;Ⅰ、Ⅱ级CHD患儿均低于Ⅲ级CHD患儿,Ⅰ级CHD患儿均低于Ⅱ级CHD患儿;轻、中度CHD合并PH患儿均低于重度CHD合并PH患儿,轻度CHD合并PH患儿均低于中度CHD合并PH患儿(P<0.05)。左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)轻、中度CHD合并PH患儿均高于重度CHD合并PH患儿,轻度CHD合并PH患儿均高于中度CHD合并PH患儿(P<0.05)。Spearman相关性分析发现,CHD合并PH患儿血清H-FABP、NT-proBNP、cTnI水平与疾病严重程度均呈正相关,LVEF、LVFS与疾病严重程度均呈负相关;血清H-FABP、NT-proBNP、cTnI水平与LVEF、LVFS均呈负相关(P<0.001)。结论CHD合并PH患儿血清H-FABP、NT-proBNP、cTnI水平随着肺平均动脉压增高呈上升趋势,且与心功能指标呈负相关,临床监测其水平变化可用来评估CHD合并PH患儿疾病进展情况,并为此类患儿临床治疗提供依据。Objective To investigate the changes and clinical significance of serum heart-type fatty acid binding protein(H-FABP),N-terminal pro brain natriuretic peptide(NT-proBNP)and troponin I(CTnI)in children with congenital heart disease(CHD)complicated with pulmonary hypertension(PH).Methods A total of 89 children with CHD admitted to the hospital from December 2017 to December 2020 were selected,and divided into the CHD with PH group(n=68)and the simple CHD group(n=21)according to the presence or absence of PH.Meanwhile,23 healthy children undergoing physical examination were selected as the healthy control group.Serum H-FABP,NT-proBNP and cTnI levels were compared between children with different grades of cardiac function in the three groups.Serum H-FABP,NT-proBNP and cTnI levels as well as cardiac function indicators in children with different severity of CHD complicated with PH were compared.The correlation between serum H-FABP,NT-proBNP and cTnI levels,cardiac function classification and the severity of CHD with PH was analyzed.The correlation between serum H-FABP,NT-proBNP and cTnI levels and cardiac function indicators was also analyzed.Results Serum H-FABP,NT-proBNP and cTnI levels were the highest in the CHD with PH group,followed by the simple CHD group and the healthy control group;the levels were the lowest in children with gradeⅠcardiac function,followed by children with gradeⅡcardiac function and children with gradeⅢcardiac function.The levels were the lowest in children with mild CHD and PH,followed by children with moderate CHD and PH and children with severe CHD and PH(P<0.05).Left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)decreased from children with mild CHD and PH,followed by children with moderate CHD and PH to children with severe CHD and PH(P<0.05).Spearman correlation analysis showed that serum H-FABP,NT-proBNP and cTnI levels were positively correlated with the severity of CHD with PH,while LVEF and LVFS were negatively correlated with the severity

关 键 词：先天性心脏病 肺动脉高压 儿童 心脏型脂肪酸结合蛋白 氨基末端B型脑钠肽前体 肌钙蛋白I 

分 类 号：R725.4[医药卫生—儿科]