室间隔缺损患儿血清氮末端脑钠素原测定的意义

Clinical Significance of N Terminal Pro-Brain Natriuretic Peptide in Children with Ventricular Septal Defects

目的研究血清氮末端脑钠素原(NT-Pro-BNP)在室间隔缺损(VSD)并心力衰竭(心衰)中的意义,为先天性心脏病并心衰的诊断和治疗提供依据。方法测定51例儿童血清NT-Pro-BNP水平。其中包括VSD患儿29例,正常儿童22例。同时行心脏彩超心功能测定,包括左心室射血分数(LVEF)和左室短轴缩短率(LVFS)等指标。结果NT-Pro-BNP值呈对数正态分布,随心衰加重,NT-Pro-BNP水平依次呈升高趋势。但无心衰组与轻度心衰组NT-Pro-BNP差异无统计学意义。重度心衰组彩超心功能测定LVEF、LVFS值与其他组间有差异,其他组之间无差异。各组心功能测定值均未达到诊断心衰的参考标准。NT-Pro-BNP水平与临床诊断心衰有较好的相关性(r=0.826),但LVEF、LVFS值与心衰无相关性。结论血NT-Pro-BNP水平可反映VSD并心衰的严重程度,且可依据其血清水平进行心衰分级。LVEF、LVFS反映小儿VSD伴心衰时不敏感,无临床意义。

Objective To assess the value of serum N terminal pro - brain natriuretic peptide（ NT - Pro - BNP） in the diagnosis of congestive heart failure（CHF） and evaluation of cardiac function in chiMren with ventricular septal defect （VSD）. Methods Fifty - one children were enrolled from March 2004 to March 2005. NT - Pro - BNP was measured by enzyme immunoassay technique. At the same time, left ventricular ejection fraction（LVEF） and left ventricular shortening fraction（LVFS） were detected with echecardiography. Results The data of NT - Pro - BNP were showed but the logarithms of which were normal distribution. The values of NT - Pro - BNP were developed successively along with the severity of cardiac function. But there was no difference between the group of no heart failure and mild heart failure. But the values of LVEF and LVFS had no differences in the control,the mild and the moderate heart failure and the same time all of which beyond the standard of diagnosing heart failure. NT - Pro - BNP could reflect the degree of heart failure or cardiac function （ r = 0. 826 ）. But LVEF and LVFS can not reflect the degree of the cardiac function. Conduslons NT - Pro - BNP can reflect the degree of the cardiac function in VSD, and the degrec of the heart failure can be classed by the levels of serum NT - Pro - BNP. But the value of LVEF and LVFS can not reflect the degree of the heart failure in the same disease.