血清N末端脑利钠肽前体与肌钙蛋白对婴幼儿充血性心力衰竭的诊断价值研究

The Diagnostic Value of Plasma NT-proBNP and CTnT in Infants with Congestive Heart Failure

目的探讨血清N末端脑利钠肽前体(NT-proBNP)与肌钙蛋白T(CTnT)在婴幼儿充血性心力衰竭的改变,以及其与CHF严重程度的关系。方法选择2009年1月—2010年1月本院住院的支气管肺炎患儿100例,按照小儿心力衰竭改良Ross标准分为0～2分(无心力衰竭)、3～6分(轻度心力衰竭)、7～12分(中-重度心力衰竭)3组,分别于治疗前及心力衰竭控制后,测定血清NT-proBNP、CTnT水平,同时测定左室射血分数(LVEF)、左室缩短分数(LVFS),同时选择同期本院健康体检婴幼儿20例为对照组。结果 (1)血浆NT-proBNP水平与临床评分之间呈明显正相关(r=0.76,P<0.01),中-重度心力衰竭组(782.7±87.2)pg/ml高于轻度心力衰竭组(517.2±61.2)pg/ml;轻度心力衰竭组高于无心力衰竭组(222.1±57.2)pg/ml;但是无心力衰竭组与正常对照组间(223.4±59.3)pg/ml差异无统计学意义。(2)血浆CTnT与临床评分无相关性,轻度心力衰竭组(0.25±0.06)μg/L与中-重度心力衰竭组(0.27±0.05)μg/L均高于无心力衰竭组(0.011±0.003)μg/L,差异有统计学意义(P<0.05)。但轻度心力衰竭组与中-重度心力衰竭组差异无统计学意义(P>0.05)。(3)血浆NT-proBNP水平与LVEF及LVFS呈负相关,而CTnT与LVEF及LVFS无明显相关性。(4)治疗后轻度心力衰竭组与中-重度心力衰竭组血清NT-proBNP水平较治疗前明显降低,差异有统计学意义(P<0.05),而治疗前及治疗后,两组血清CTnT水平比较,差异无统计学意义(P>0.05)。结论血清NT-proBNP与CTnT水平可用于婴幼儿充血性心力衰竭诊断与分度,血清NT-proBNP与CTnT相比更适用于判断心力衰竭控制的生化指标。

Objective To investigate the values of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)and cardiac troponin T(CTnT)in infants with congestive heart failure (CHF),and analyze the relationship between these changes and the severity of CHF.Methods According to Ross criteria,100 patients with pneumonia complicated with CHF were divided into three groups ( No CHF,Mild CHF,Moderate to Severe CHF).Plasma NT-proBNP and CTnT,together with LVEF and LVFS were measured before and after CHF were under control.20 healthy infants served as controls (Control group).Results (1) The concentration of Plasma NT-proBNP correlates well with clinical severity (Ross scores) (r=0.76,P<0.01),higher in Moderate to Severe CHF group(782.7±87.2) pg/ml than in Mild CHF group(517.2±61.2) pg/ml;higher in Mild CHF group than in No CHF group(222.1±57.2) pg/ml;there is no statistical difference in No CHF group and Control group(223.4±59.3) pg/ml.(2) The concentration of Plasma CTnT does not correlates with Ross scores.It is higher in Mild CHF group(0.25±0.06) μg/L and Moderate to Severe CHF group(0.27±0.05) μg/L than in No CHF group(0.011±0.003) μg/L(P<0.05),but there is no significant difference between Mild CHF group and Moderate to Severe CHF group.(3)The concentration of Plasma NT-proBNP correlates negatively with LVEF and LVFS,while that of CTnT does not correlates with LVEF and LVFS.(4)Plasma NT-proBNP differs significantly before and after CHF controlled in both Mild CHF group and Moderate to Severe CHF group,but that difference does not exist in CTnT levels.Conclusion Plasma NT-proBNP and CTnT could be useful index for the CHF diagnosis and severity estimation in infants,with NT-proBNP be better in judging if CHF were controlled.