血清氮末端脑钠肽原对儿童心力衰竭的诊断价值

Diagnostic Value of Serum N-Terminal Pro-B-Type Natriuretic Peptide Levels on Heart Failure in Children

目的评价血清氮末端脑钠肽原(NT-proBNP)在儿童心力衰竭(心衰)诊断中的价值,分析其与临床纽约心脏病协会(NYHA)心功能分级和超声心动图所测指标的相关性。方法将本院收治的40例心脏疾病患儿纳入病例组,根据NYHA心功能分级标准分为心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ4个级别,同时选取26例健康儿童作为健康对照组。用电化学发光法检测2组儿童血清NT-proB-NP水平,并行超声心动图检查,记录左室射血分数(LVEF)、左室短轴缩短分数(LVFS)值。健康对照组与心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级4个组别之间血清NT-proBNP水平、LVEF、LVFS数值的比较采用单因素方差分析。血清NT-proBNP与LVEF、LVFS的相关性及三者与心衰严重程度的相关性分析用Pearson相关系数表达。绘制ROC曲线并计算相应的曲线下面积,以评估血清NT-proBNP及LVEF、LVFS对心衰的诊断价值。结果 1.NT-proBNP值呈对数正态分布,在心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患儿中,血清NT-proBNP水平依次显著升高(Pa<0.05);心功能Ⅱ、Ⅲ、Ⅳ级患儿血清NT-proBNP水平均显著高于健康对照组(Pa<0.05)。2.病例组NT-proBNP对数值与LVEF、LVFS值均呈负相关(r=-0.584、-0.216,Pa<0.05)。3.以血清NT-proBNP 212 ng.L-1作为区分有无心衰的临界点,诊断心衰的灵敏度为91.2%,特异度为93.7%;NT-proBNP、LVEF、LVFS的ROC曲线下面积分别为96.8%、25.0%、43.2%,LVEF、LVFS诊断儿童心衰不敏感。4.病例组血清NT-proBNP与心功能分级的相关系数(r=0.890,P<0.05)明显高于LVEF、LVFS与心功能分级的相关系数(r=0.585、0.339,Pa<0.05)。结论血清NT-proBNP是诊断心衰的灵敏且特异性指标,同时可准确地反映心衰的严重程度。

Objective To evaluate the diagnostic value of N-terminal pro-B-type natriuretic peptide（NT-proBNP） on heart fai-lure in children and analyze the correlation of serum NT-proBNP with New York Heart Association（NYHA） heart functional class and echocardiographic derived parameters of cardiac function.Methods Forty children with heart disease in the Affiliated Hospital of Nantong University were selected as case group,and they were divided into Ⅰ,Ⅱ,Ⅲ and Ⅳ group according to NYHA heart functional class,and 26 healthy children were selected into healthy control group at the same time.Serum level of NT-proBNP was measured by electrochemiluminescence,left ventricular ejection fraction（LVEF）and left ventricular fraction shorting（LVFS） were recorded by using echocardiogram.The comparisons of serum levels of NT-proBNP,LVEF and LVFS among healthy control group and Ⅰ,Ⅱ,Ⅲ,Ⅳ NYHA heart functional groups were made by One-Way Anova.The correlation between serum levels of NT-proBNP and LVEF,LVFS were expressed by Pearson correlation coefficient.The same method was applied in analyzing the correlation between the upper three indexes and the severity of heart failure.Diagnostic value of serum levels of NT-proBNP,LVEF and LVFS on heart failure were evaluated by drawing ROC-curve and calculating the corresponding areas under it.Results 1.The results of NT-proBNP were skewed but the logarithms of which were normal distribution.The se-rum levels of NT-proBNP in patients with Ⅰ,Ⅱ,Ⅲ,Ⅳ NYHA heart functional class increased significantly in turn（Pa〈0.05）.The serum levels of NT-proBNP in patients with Ⅱ,Ⅲ,Ⅳ NYHA heart functional class were all significantly higher than that in healthy control group（Pa〈0.05）.2.In case group,the value of Log NT-proBNP was negatively correlated with the value of LVEF and LVFS（r=-0.584,-0.216,Pa〈0.05）.3.Taking the serum level 212 ng·L-1 of NT-proBNP as the optimal cutoff value,the sensitivity and the specificity of diagnosis of heart failure were 91.2% and 93.7%.The corresponding areas under ROC-curve of NT-proBNP,LVEF and LVFS were 96.8%,25.0% and 43.2% respectively.LVEF and LVFS could not diagnose heart failure sensitively.4.In case group,correlation analysis revealed a strong correlation between NT-proBNP and HYHA classification（r=0.890,P0.05）and a weak correlation between LVEF and HYHA classification（r=0.585,P〈0.05） as well as between LVFS and HYHA classification（r=0.339,P〈0.05）.Conclusions The serum level of NT-proBNP can reflect the cardiac function accurately.NT-proBNP has high sensitivity and specificity for diagnosis of heart failure in children.