急性充血性心力衰竭患儿血浆脑利钠肽变化的意义

Significance of Peptide Brain Natriuretic Peptide in Children with Acute Congestive Heart Failure

目的通过测定急性充血性心力衰竭(CHF)患儿血浆脑利钠肽(BNP)水平的变化,进一步确定其临床应用价值。方法BNP测定采用酶标法;选择住院CHF患儿48例,其中肺炎心衰36例,先天性心脏病心衰12例。正常对照组40例。分别进行CHF组不同时期BNP水平与正常对照组比较,探讨CHF患儿心功能参数变化并与BNP水平作相关分析。根据NYHA小儿CHF分级,进行不同心功能级别CHF患儿BNP比较。结果CHF患儿心衰期及恢复期BNP水平显著高于正常对照组(t=14.30,20.38 P均<0.01);CHF患儿心衰期CI、LVEF值与正常对照组比较有显著差异(t=8.85,12.62 P均<0.01),恢复期CI及LEVF值与正常对照组比较差异无显著(t=1.62,1.64 P均>0.05),提示心衰时心功能有明显的改变。同时心衰患儿BNP与CI、LVEF数值均呈负相关(r=-0.61,-0.79 P均>0.05);心功能分级不同,BNP水平明显不同,心衰程度越重,BNP水平愈高,差异有显著性(P均<0.01)。结论心衰时BNP水平明显增高,确定BNP在CHF诊断中价值。并与动态心功能变化密切相关;心衰程度越重,血BNP水平越高。BNP可作为评价心功能程度及预后,指导临床治疗的指标。

Objective To detect brain natriuretic peptide（BNPs） level in serum in order to confirm its applical value. Methods Forty - eight patients with congestive heart failure（CHF） were chosen, which included 36 patients with pneumonia, 12 patients with congenital heart diseases. Forty heathy children were chosen as control group. BNPs level of two groups were detected by enzyme label. Results The level of BNP in patiems with CHF（ that＇s positive group） was obviously higher than that in control group in the stage of CHF and recoverty（t=14.30,20.38 all P〈0.01;its Cl and LVEF were also increased in positive group in the stage of CHF（t=8.85,2.62 all P〈0.01 ） ,while the level of C1 and LVEF kept invariant in 2 groups（ t=1.62,1.64 all P〉0.05） ,this included that the cardiac function had significantly changes in the stage of CHF,at the same time,the level of BNP had negative correlation to C1 and LVEF（ r=-0.61, - 0.79 all P〈0.05）. The level of BNP was different with various heart function, statistic study display that higher level of BNP and the worse heart function, it＇s significant （ P〈0.01 ）. Conclusions The level of BNP in patients with CHF is obviously higher than that in control group. This confirms its value in the diagnosis of CHF,and it correlates to the change of cardiac function. The higher level of BNP, the worse heart function. BNP is a guideline of cardiac function, prognosis and clinical treament.