不同病因急性心力衰竭患儿血清氨基末端脑钠素原水平变化及其与肺动脉高压的关系

Changes of Serum Levels of N-Terminal Pro-Brain Natriuretic Peptide in Children with Congestive Heart Failure Complicated with Different Pathogeny and Its Relationship with Pulmonary Hypertension

目的探讨先天性心脏病、肺炎并心力衰竭患儿血清氨基末端脑钠素原(NT-proBNP)水平变化及其与肺动脉高压(PH)的关系。方法采用竞争性酶免疫法检测66例住院心力衰竭患儿(肺炎并心力衰竭25例,先天性心脏病并肺炎心力衰竭22例,先天性心脏病并中重度PH心力衰竭19例)及60例对照组患儿(肺炎、先天性心脏病、健康儿童各20例)外周血NT-proBNP水平。多普勒超声心动图检测心力衰竭患儿心室射血分数(LVEF)、缩短分数(FS),对先天性心脏病患儿估测肺动脉压力。结果1.肺炎心力衰竭组及先天性心脏病心力衰竭组NT-proBNP水平无显著差异(P>0.05),但二组均较相应对照组(肺炎对照组、先天性心脏病对照组)显著增高(Pa<0.001);先天性心脏病并中重度PH心力衰竭组较先天性心脏病无PH或轻度PH心力衰竭组水平亦明显增高(Pa<0.05)。2.三组心力衰竭患儿间LVEF、FS水平比较差异无显著性(Pa>0.05)。3.肺炎对照组、先天性心脏病对照组较正常对照组NT-proBNP水平略高,但无统计学意义(Pa>0.05)。结论血清NT-proBNP对肺炎心力衰竭、先天性心脏病并心力衰竭均有较敏感而特异的诊断价值,且随肺动脉压力增高而呈增高趋势。

Objective To explore the changes of serum levels of N - terminal pro - brain natriuretic peptide（ NT - proBNP） in pediatric patients with congenital heart disease（CHD） complicated with acute congestive heart failure （CHF） and pneumonia complicated with acute CHF and its relationship with pulmonary hypertension（PH）. Methods The serum NT - proBNP concentrations were detected with competitive enzyme immunoassay（EIA） in 66 CHF children and 60 control children. Left ventricular ejection fraction（LVEF） and fractional shorting （FS） were measured by doppler uhrasonography cardiogram in children with CHF . Pulmonary pressure was also estimated in children with CHD. Results 1. There was no statistic significance in the NT - proBNP concentration between the pneumonia complicated with CHF group and CHD complicated with CHF group （ P 〉 0.05 ）. There were statistic significances between the pneumonia complicated with CHF and pneumonia groups, CHD complicated with CHF and CHD groups respectively （Pa 〈0. 001 ）. The NT - proBNP level in CHD group complicated with CHF with moderate to severe PH was also significantly higher than those in CHD group complicated with CHF without PH or with mild PH（Pa 〈0.05）. 2. There was no statistic significance in the LVEF and FS level among the three CHF groups （Pa 〉0.05）. 3. NT - proBNP concentrations in control groups of pneumonia and CHD were higher than those in normal control group, but there was no statistic significance （Pa 〉 0.05）. Conclusions Serum NT - proBNP level is sensitive and specific for the diagnosis of pneumonia complicated with CHF and CHD complicated with CHF. There is an increasing tendency of NT - proBNP level companied increasing pulmonary pressure.