可溶性生长刺激表达基因2蛋白和氨基末端B型利钠肽在儿童先天性心脏病围手术期的变化及其临床意义  

Changes and clinical roles of perioperative NT-proBNP and soluble ST2 in children with congenital heart disease

作　　者：孔祥萦 孟雅玲 顾群 KONG Xiangying;MENG Yaling;GU Qun(Department of Cardiovascular Surgery,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院心脏大血管外科,南京210029

出　　处：《医学研究与战创伤救治》2025年第2期149-155,共7页Journal of Medical Research & Combat Trauma Care

基　　金：国家自然科学基金(82370376);国家重点专科建设项目(2024年度)(Cz1320240102);江苏省科教能力提升工程(ZDXK202230)。

摘　　要：目的探讨氨基末端B型利钠肽(NT-proBNP)和可溶性生长刺激表达基因2蛋白(sST2)在简单型和复杂型儿童先天性心脏病(CHD)外科体外循环(CPB)手术前后的变化及其临床意义。方法回顾性分析2022年1月至2023年12月在南京医科大学第一附属医院心脏大血管外科龙江院区(小儿胸心)手术的0~12岁的CHD患儿117例的临床资料,其中简单型46例、复杂型71例。收集所有患儿的临床资料,比较观察简单型和复杂型CHD患儿围手术期血清NT-proBNP和s ST2水平变化,分析其与临床变量的相关性和对早期结果的预测价值。结果CHD患儿术后NT-proBNP(3315.54±3052.24)pg/m L和s ST2(260.76±130.06)pg/m L水平显著高于术前(P<0.01),且复杂型CHD患儿围手术期心肌标志物水平均显著高于简单型CHD患儿(P<0.01)。其水平与年龄(NT-proBNP术前r=-0.821、术后r=-0.791,sST2术前r=-0.300、术后r=-0.406,P<0.01)、体质量(NT-proBNP术前r=-0.846、术后r=-0.784,sST2术前r=-0.263、术后r=-0.413,P<0.01)呈负相关,与CPB时间(NT-proBNP术前r=0.439、术后r=0.459,sST2术前r=0.189、术后r=0.432,P<0.01)、手术时间(NT-proBNP术前r=0.318、术后r=0.372,sST2术后r=0.455,P<0.01)呈正相关(P<0.05)。多因素logistic回归分析结果显示,术后NTpro BNP(OR=1.093)和术前s ST2(OR=1.268)是患儿术后呼吸机辅助时间延长的独立影响因素;术后NT-proBNP(OR=1.041)和s ST2(OR=1.171)是住监护室时间延长的独立危险因素;而术后s ST2(OR=1.041)是患儿住院时间延长的独立危险因素。结论CHD患儿围手术期NT-proBNP和s ST2水平受多种因素影响,包括年龄、类型、体质量及CPB时间等,联合应用对患儿术后早期结果有更好的预测价值。Objective This study aims to evaluate the changes of N-terminal pro-B-type natriuretic peptide(NT-proBNP)and soluble growth stimulating gene 2 protein(sST2)levels before and after cardiopulmonary bypass(CPB)surgery in children with simple and complex congenital heart disease(CHD).Methods A retrospective analysis was carried out among 117 children with CHD(aged 0-12 years old)(46 simple CHD patients and 71 complex CHD patients)who underwent cardiac surgery in the Department of Pediatric Cardiothoracic Surgery of Longjiang Branch of the First Affiliated Hospital of Nanjing Medical University from January 2022 to December 2023.The clinical data of these CHD patients and the NT-proBNP and soluble ST2 results before and after operation were collected.The changes of perioperative NT-proBNP and soluble ST2 were analyzed,the correlations were evaluated,and the predictive value of postoperative early outcomes were explored.Results The pre-operation levels of NTproBNP(3315.54±3052.24)and soluble ST2(260.76±130.06)were higher than post-operation,and that in complex CHD children was higher than that of simple CHD children.The levels of NT-proBNP and soluble ST2 were negatively correlated with age(NT-proBNP pre-operation r=-0.821,post-operation r=-0.791,sST2 pre-operation r=-0.3,post-operation r=-0.406,P<0.01)and body mass(NT-proBNP pre-operation r=-0.846,post-operation r=-0.784,sST2 pre-operation r=-0.263,post-operation r=-0.413,P<0.01),and that were positively correlated with ex-tracorporeal circulation time(NT-proBNPpre-operation r=0.439,post-operation r=0.459,sST2 pre-operation r=0.189,post-operation r=0.432,P<0.01)and operation time(NT-proBNP pre-operation r=0.318,post-operation r=0.372,sST2 post-operation r=0.455,P<0.01).Multivariate Logistic regression analysis showed that postoperative NT-proBNP(OR=1.093)and preoperative soluble ST2(OR=1.268)were independent influencing factors for the prolongation of postoperative ventilator-assisted time in children.Postopera-tive NT-proBNP(OR=1.041)and soluble ST2(OR=1.171)were i

关 键 词：先天性心脏病 可溶性生长刺激表达基因2蛋白 氨基末端脑利钠肽前体 儿童 围手术期 

分 类 号：R725.4[医药卫生—儿科]