儿科急诊患儿B型钠尿肽升高的疾病谱分析及其严重性评估  

Analysis of of disease spectrum and assessment of disease severity of elevated B-type natriuretic peptide in pediatric emergency patients

作　　者：吕芳[1] 曲东[1] 郭琳瑛[1] 李莉娜[1] 石宠 LV Fang;QU Dong;GUO Linying;LI Lina;SHI chong(Department of Critical Care Medicine,Children’s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院重症医学科,100020

出　　处：《心肺血管病杂志》2023年第7期693-697,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医管局儿科专项创新推广项目(XTCX201820)。

摘　　要：目的:对儿科急诊患儿BNP检测升高的疾病谱进行分析并对其严重性进行评估。方法:于2020年1月1日至2020年12月31日期间,对在首都儿科研究所附属儿童医院急诊科就诊的可疑有心脏疾病或入抢救室病情危重的患儿,采用床旁Alere Triage心肺功能五联检测试板进行BNP检测;同期进行超声心动图检查,并对其中BNP>100 ng/L患儿的资料进行回顾性研究。结果:2020年期间,在急诊就诊者共141836人次,其中3945例(2.8%)进行了BNP检测,>100 ng/L共115例。115例患儿中男60例,女55例,年龄1天~15岁,中位数1岁。其中住院者94例(81.7%),多数入住于ICU(39例,41.5%)及心血管内科(26例,27.7%)。疾病谱包括先天性心脏病、川崎病、肺动脉高压、急性心肌炎、心肌病、严重心律失常等,其他疾病以脓毒症多见。心力衰竭者47例,心力衰竭组与无心力衰竭组BNP中位数分别为1165 ng/L和168 ng/L,差异有统计学意义(Z=-6.466,P<0.001)。超声心动图显示心脏结构和/或功能异常组的BNP值显著高于正常组,但心力衰竭患者中22例LVEF减低组与25例LVEF正常组的BNP比较无明显差异。死亡11例(9.6%),死亡组患者BNP中位数为1649 ng/L,存活组为758.5 ng/L,差异无统计学意义(Z=-1.75,P=0.08)。结论:儿科急诊患者BNP升高最常见的原因为多种疾病引起的心力衰竭、川崎病、肺动脉高压及脓毒症。床旁快速BNP检测有助于及时发现危重病例,与超声心动图检查具有协同互补作用。Objective:To analyse the disease spectrum of elevated BNP in pediatric emergency patients and assess of the severity of the illnesses.Methods:Between 1 January 2020 and 31 December 2020,bedside Alere Triage cardiopulmonary function five-test(including BNP)board were tested in the patients with severe conditions in the emergency department of the Children's Hospital affiliated the Capital Institute of Paediatrics.Ultrasound cardiogram examinations were performed the same day.Data from children with BNP greater than 100 ng/L were reviewed.Results:During the year 2020,there were 141836 emergency visits in our hospital,of which 3945(2.8%)were tested for BNP.More than 115 cases were greater than 100 ng/L.60 cases were male and 55 cases were female,Age ranged from 1 day to 15 years old,the median age was 1 year old.94(81.7%)patients were hospitalized.Most of them were admitted to the ICU(39 cases,41.5%)and cardiovascular medicine department(26 cases),while a few patients were admitted to other departments such as hematology and neurology department.There were as many as 47 cases of heart failure.The spectrum of disease in elevated BNP involves Congenital heart disease,Kawasaki disease,sepsis,ARDS,cardiomyopathy,acute myocarditis,severe arrhythmia,etc.and a variety of causes were Kawasaki disease,pulmonary hypertension and sepsis.The median BNP in the heart failure group and the non-heart failure group were 1165ng/L and 168 ng/L respectively,and the difference was statistically significant(Z=-6.466,P<0.01).The BNP values of the abmormal heart structure and/or dysfunction group which echocardiography showed were significantly higher than that in the normal group.However,there was no significant difference of BNP values between the LVEF reduction group(22 cases)and the normal LVEF group(25 cases)in patients with heart failure.There were 11 deaths(9.6%),the median BNP in the death group was 1649 ng/L and the survival group was 758.5 ng/L,and there was no statistically significance(Z=-1.75,P=0.08).Conclusions:The most commo

关 键 词：脑钠肽 急诊 儿童 心力衰竭 超声心动图 

分 类 号：R54[医药卫生—心血管疾病]