氨基末端脑钠肽前体在早期诊断早产儿支气管肺发育不良及合并肺动脉高压中的研究进展  

Progress of N-terminal pro-brain natriuretic peptide in early diagnosis of bronchopulmonary dysplasia and pulmonary hypertension in premature infants

作　　者：孙梦泽 侯阿娜[1] Sun Mengze;Hou A'na(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院儿科,沈阳110004

出　　处：《中国小儿急救医学》2024年第3期206-209,共4页Chinese Pediatric Emergency Medicine

基　　金：辽宁省重点研发计划联合计划(2020JH2/10300132);中华国际医学交流基金会公益基金(Z-2019-41-2101-04);中国医科大学附属盛京医院345工程项目;辽宁省社发重大专项(2020JH1/1030001)。

摘　　要：早产儿支气管肺发育不良(BPD)是影响早产儿预后的严重并发症之一,中重度BPD合并肺动脉高压(BPD-PH)的发生率较高,并会进一步增加BPD患儿的病死率。而BPD发展阶段较长,待纠正胎龄36周才能够明确诊断,BPD-PH临床表现也缺乏特异性,诊断的金标准心导管检查属于有创检查,常用的超声心动图检查也受操作者经验影响较大,因此早期识别BPD及BPD-PH受限。氨基末端脑钠肽前体(NT-proBNP)由心室肌细胞在容量或压力超负荷刺激下分泌,既往在先天性心脏病中评估心脏负荷时应用较多。近期研究发现,BPD患儿在生后1周内及BPD发展阶段,血中NT-proBNP水平增高;且纠正胎龄28~36周,NT-proBNP水平显著升高预测BPD-PH的灵敏度及特异度均较高。因此,NT-proBNP有望成为早期预测BPD及BPD-PH的生物标志物。本文对NT-proBNP的生物学功能、代谢特点、在BPD及BPD-PH中的研究进展进行综述,以期借助NT-proBNP作为BPD及BPD-PH的早期预测指标,对具有高危因素的早产儿进行早期识别、及时干预、改善预后。Bronchopulmonary dysplasia(BPD)is a significant complication that greatly impacts the prognosis of preterm infants.The incidence of pulmonary hypertension(PH)in preterms with moderate to severe BPD is relatively high,which further increases the mortality among infants with BPD.Diagnosis of BPD could be made until 36 weeks corrected gestational age,and the clinical manifestations of BPD-PH are also not specific enough for accurate identification.Cardiac catheterization is considered the gold standard for diagnosis,which is an invasive procedure,while echocardiography heavily relies on the experience of operator,limiting early detection of both BPD and BPD-PH.N-terminal pro-brain natriuretic peptide(NT-proBNP),secreted by ventricular myocytes in response to volume or pressure overload,has been widely utilized in assessing cardiac load in cases of congenital heart disease.Recent studies have shown that the blood NT-proBNP levels significantly elevate in infants with BPD within one week after birth and during the development stage of BPD.Additionally,there is a substantial increase in NT-proBNP levels from 28 to 36 weeks corrected gestational age,which has both high sensitivity and high specificity in predicting the occurrence of BPD-PH.Therefore,NT-proBNP is expected to serve as a biomarker for the early prediction of BPD and BPD-PH.This review summarized the biological function,metabolic characteristics,and current research advancements regarding NT-proBNP in BPD and BPD-PH.The aim is to utilize NT-proBNP as an early predictor for BPD and BPD-PH,enabling timely identification of premature infants with high risk factors of these diseases,and facilitating prompt intervention to ultimately enhance prognosis.

关 键 词：支气管肺发育不良 肺动脉高压 氨基末端脑钠肽前体 早产儿 

分 类 号：R722.6[医药卫生—儿科]