血浆氮末端脑利钠肽前体检测在左向右分流型先天性心脏病婴儿合并肺炎时的临床意义
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摘要
目的探讨血浆氮末端脑利钠肽前体(NT-proBNP)在左向右分流型先天性心脏病(CHD)婴儿患肺炎时的临床意义。方法选择2015年2月至2016年4月安徽省儿童医院心内科收治的45例左向右分流型CHD病合并肺炎的婴儿(年龄1～12个月)纳入研究。根据改良Ross评分分为无心力衰竭(心衰)和轻、中、重度心衰。根据CHD结构异常情况,分为单一畸形和复合/复杂畸形。另选择同期同年健康婴儿12例为照组。检测入院和出院时所有婴儿的NT-proBNP水平和改良Ross评分。结果入院时,无心衰者15例,轻、中、重度心衰婴儿分别为13例、13例和4例;单一畸形者21例,复合/复杂畸形者24例。治疗中,死亡和放弃治疗各1例,均为复合/复杂畸形婴儿。出院时,无心衰者37例,轻度心衰者6例,无中度及重度心衰婴儿;单一畸形者21例,复合/复杂畸形者22例。入院时,各级心衰婴儿间NT-proBNP的对数lg(NT-proBNP)水平比较,重度心衰高于中度心衰(P=0.018),中度和轻度心衰高于无心衰和对照组(P<0.001),复合/复杂畸形婴儿中、重度心衰构成比高于单一畸形婴儿(P<0.001)。出院时,轻度心衰婴儿lg(NT-proBNP)高于无心衰和对照组(均为P=0.001),复合/复杂畸形婴儿心衰构成比依然高于单一畸形婴儿,差异有统计学意义(P=0.010)。入院和出院时所有婴儿NT-proBNP和改良Ross评分均呈正相关(r_s=0.777,P<0.001和r_s=0.646,P<0.001)。结论 lg(NT-proBNP)可以反映左向右分流型CHD婴儿心力衰竭的严重程度,复合或复杂型左向右分流型CHD婴儿患肺炎时更易出现严重心力衰竭和难于治疗。
Objective To investigate the clinical application of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP) in infants with left-to-right shunt congenital heart disease(CHD) combined with pneumonia.Methods Forty-five infants with left-to-right shunt CHD combined with pneumonia,who were aged 1 to 12 months and hospitalized in Department of Cardiovascular Medicine of Anhui Provincial Children's Hospital from February 2015 to April 2016,were enrolled into the study.According to the numeral value of modified Ross score,heart failure(HF) was classified into without HF,light HF,medium HF and severe HF,and according to specific anatomy,cardiac malformation was classified as single and composite/complex malformation.Twelve healthy infants with the same age during the corresponding time were included in the control group.The level of NT-proBNP and numeral value of modified Ross score were detected in all infants on admission and at discharge.Results On admission,there were 15 cases without HF,13 cases with light HF,13 cases with medium HF and 4 cases with severe HF.Among them,21 cases had single malformation,while 24 cases had composite/complex malformation.Neither medium nor severe HF infants were found at discharge,but there were 37 cases without HF and 6 cases with light HF.And among them,there were 21 cases of single malformation and 22 cases of composite/complex malformation.On admission,the level of logarithm of NT-proBNP lg(NT-proBNP) was higher in infants with severe HF than with medium HF(P=0.018),and higher in infants with medium and light HF than without HF and control group(P<0.001).The proportion of medium or severe HF was higher in infants with composite/complex malformation in comparison with those with single malformation(P<0.001).At discharge,the level of lg(NT-proBNP) was higher in infants with light HF than infants without HF or the control group(all P=0.001).The proportion of HF was still statistically higher in infants with composite/complex malformation than infants with single malformation,and the difference was statistically significant(P=0.010).There were 1 case of death and 1 case of abandoning therapy,who were both infants with composite/complex malformation.In all infants with left-to-right CHD,the levels of NT-proBNP and modified Ross score showed significantly positive correlation(on admission:r_s=0.777,P<0.01;at discharge:r_s=0.646,P<0.01).Conclusion The level of lg(NT-proBNP) can reflect the severity of heart failure in infants with left-to-right CHD.And infants with complex or composite left-to-right CHD when suffering from pneumonia are much easier to present severe HF and more difficult to treat.
Objective To investigate the clinical application of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP) in infants with left-to-right shunt congenital heart disease(CHD) combined with pneumonia.Methods Forty-five infants with left-to-right shunt CHD combined with pneumonia,who were aged 1 to 12 months and hospitalized in Department of Cardiovascular Medicine of Anhui Provincial Children's Hospital from February 2015 to April 2016,were enrolled into the study.According to the numeral value of modified Ross score,heart failure(HF) was classified into without HF,light HF,medium HF and severe HF,and according to specific anatomy,cardiac malformation was classified as single and composite/complex malformation.Twelve healthy infants with the same age during the corresponding time were included in the control group.The level of NT-proBNP and numeral value of modified Ross score were detected in all infants on admission and at discharge.Results On admission,there were 15 cases without HF,13 cases with light HF,13 cases with medium HF and 4 cases with severe HF.Among them,21 cases had single malformation,while 24 cases had composite/complex malformation.Neither medium nor severe HF infants were found at discharge,but there were 37 cases without HF and 6 cases with light HF.And among them,there were 21 cases of single malformation and 22 cases of composite/complex malformation.On admission,the level of logarithm of NT-proBNP lg(NT-proBNP) was higher in infants with severe HF than with medium HF(P=0.018),and higher in infants with medium and light HF than without HF and control group(P<0.001).The proportion of medium or severe HF was higher in infants with composite/complex malformation in comparison with those with single malformation(P<0.001).At discharge,the level of lg(NT-proBNP) was higher in infants with light HF than infants without HF or the control group(all P=0.001).The proportion of HF was still statistically higher in infants with composite/complex malformation than infants with single malformation,and the difference was statistically significant(P=0.010).There were 1 case of death and 1 case of abandoning therapy,who were both infants with composite/complex malformation.In all infants with left-to-right CHD,the levels of NT-proBNP and modified Ross score showed significantly positive correlation(on admission:r_s=0.777,P<0.01;at discharge:r_s=0.646,P<0.01).Conclusion The level of lg(NT-proBNP) can reflect the severity of heart failure in infants with left-to-right CHD.And infants with complex or composite left-to-right CHD when suffering from pneumonia are much easier to present severe HF and more difficult to treat.
引文
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[7] 傅之妍,黄斌,黄韵.PCT 和 NT-proBNP 对脓毒血症患者生存状况的预测价值[J].安徽医药,2015,19(3):513-515.
[8] 朱磊,钱同,张晓文,等.手足口病患儿血浆氨基末端脑利钠肽前体及去甲肾上腺素检测的临床意义[J].安徽医药,2015,19(8):1521-1522.
[9] 张冲,聂娜娜,李伟,等.BNP对左向右分流型小儿先天性心脏病心功能评价[J].青岛大学医学院学报,2014,50(4):333-335,338.
[10] 吴萍,王玉杰.室间隔缺损患儿早期心血管功能异常评估与NT-proBNP的关系研究[J].儿科药学杂志,2016,22(8):4-6.
[11] SAMUEL N,HERSHKOVITZ T,BRIK R,et al.Diagnosing heart failure in children with congenital heart disease and respiratory syncytial virus bronchiolitis[J].The American Journal of Emergency Medicine,2014,32(12):1510-1512.
[12] 李伟,毛成刚,聂娜娜,等.先天性心脏病心力衰竭病儿外周血和肽素、BNP和CRP变化及意义[J].青岛大学医学院学报,2015,51(1):19-22.
[13] EINDHOVEN JA,VAN DEN BOSCH AE,JANSEN PR,et al.The usefulness of brain natriuretic peptide in complex congenital heart disease[J].Journal of the American College of Cardiology,2012,60(21):2140-2149.
[2] ELASFAR A.Correlation between plasma N-terminal pro-brain natriuretic peptide levels and changes in New York Heart Association functional class,left atrial size,left ventricular size and function after mitral and/or aortic valve replacement[J].Ann Saudi Med,2012,32(5):469-472.
[3] POPELOVá JR,KOTA?KA K,TOMKOVá M,et al.Usefulness of N-terminal pro-brain natriuretic peptide to predict mortality in adults with congenitalheart disease[J].The American Journal of Cardiology,2015,116(9):1425-1430.
[4] CANTINOTTI M,PASSINO C,STORTI S,et al.Clinical relevance of time course of BNP levels in neonates with congenital heart diseases[J].Clin Chim Acta,2011,412(23/24):2300-2304.
[5] CASELLI C,RAGUSA R,PRONTERA C,et al.Distribution of circulating cardiac biomarkers in healthy children:from birth through adulthood[J].Biomarkers Med,2016,10(4):357-365.
[6] SAHIN M,PORTAKAL O,KARAG?Z T,et al.Diagnostic performance of BNP and NT-proBNP measurements in children with heart failure based on congenital heart defects and cardiomyopathies[J].Clin Biochem,2010,43(16/17):1278-1281.
[7] 傅之妍,黄斌,黄韵.PCT 和 NT-proBNP 对脓毒血症患者生存状况的预测价值[J].安徽医药,2015,19(3):513-515.
[8] 朱磊,钱同,张晓文,等.手足口病患儿血浆氨基末端脑利钠肽前体及去甲肾上腺素检测的临床意义[J].安徽医药,2015,19(8):1521-1522.
[9] 张冲,聂娜娜,李伟,等.BNP对左向右分流型小儿先天性心脏病心功能评价[J].青岛大学医学院学报,2014,50(4):333-335,338.
[10] 吴萍,王玉杰.室间隔缺损患儿早期心血管功能异常评估与NT-proBNP的关系研究[J].儿科药学杂志,2016,22(8):4-6.
[11] SAMUEL N,HERSHKOVITZ T,BRIK R,et al.Diagnosing heart failure in children with congenital heart disease and respiratory syncytial virus bronchiolitis[J].The American Journal of Emergency Medicine,2014,32(12):1510-1512.
[12] 李伟,毛成刚,聂娜娜,等.先天性心脏病心力衰竭病儿外周血和肽素、BNP和CRP变化及意义[J].青岛大学医学院学报,2015,51(1):19-22.
[13] EINDHOVEN JA,VAN DEN BOSCH AE,JANSEN PR,et al.The usefulness of brain natriuretic peptide in complex congenital heart disease[J].Journal of the American College of Cardiology,2012,60(21):2140-2149.