小儿心力衰竭N端脑利钠肽原的临床价值

Clinical value of serum concentration of N-tertrdnal pro-brain natriuretic peptide in congestive heart failure in pediatric patients

目的探讨血清N端脑利钠肽原（N-terminal pro-brain natriuretic peptide，NT-proBNP）对小儿充血性心力衰竭（congestive heart failure，CHF）的诊断和心功能评估价值。方法2006年1月至2007年3月在中山大学附属第一医院心血管儿科以不同病因所致的心功能受损患儿93例为研究组，男44例，女49例，年龄1个月至14岁，平均2．1岁。改良Ross评分≥3作为心衰参考标准，无心衰者（0—2分）35例、轻度心衰（3—6分）25例、中度心衰（7．9分）16例、重度心衰（10～12分）17例。对照组43例，为同期非心脏病住院且无心力衰竭患儿，男21例，女22例，年龄1个月～12岁，平均2．0岁。应用电化学发光双抗体免疫夹心分析法检测血清NT-proBNP，同时超声心动图测定左室射血分数（1eft ventricular ejection fraction，LVEF）。应用SPSS11．0软件进行统计分析和ROC曲线制作。数据以均数±标准差（x^-±s）或中位数M表示。NT-proBNP、LVEF的组间差异的显著性分析用单因素方差分析。NT-proBNP水平分别与Ross评分心功能分级和IM强行直线相关分析。P〈0．05为差异有统计学意义。结果研究组和对照组在年龄、性别差异无统计学意义（P〉0．05）。研究组与对照组血清NT-proBNP分别为504．3（13．2—66664．0）pg／na、94（9．1—574．0）pg／ml。两者比较差异具有统计学意义（P〈0．01）；血清NT-proBNP水平与改良Ross评分心功能分级呈正相关（r=0．79，P〈0．01），与LVEF呈负相关（r=-0．42，P〈0．01）。血清NT-proBNP≥344pg／ml为诊断心衰阈值，敏感性89．7％，特异性90％，ROC曲线下面积0．95。结论血清NT-proBNP水平可作为小儿心衰早期诊断的敏感和特异指标，其升高水平与临床心衰程度关系密切。

Objective To assess the value of serum N-terminal pro-brain natriuretic peptide （NT-proBNP） in the diagnosis of congestive heart failure （CHF） and evaluations of cardiac function in pediatric patients. Method Totally 93 patients, aged from 1 month to 14 years old （median 2.1 years old）, were enrolled as the study group. According to the modified Ross Score, these patients were divided into four groups, abscence of CHF group （35 patients）, mild CHF group （25 patient）, moderate CHF group （ 16 patients） and severe CHF group （ 17 patients）. Totally 43 matched patients without heart diease and heart failure served as the controls. Sertma NTproBNP and the left ventricular ejection fraction （LVEF） were measured using the electrochemiluminescence immunoassay and echocardiography respectively in all cases. Statistical analysis and ROC curve were carried out in with SPSS 11.0 software. The data were expressed as moan ＋ standard deviation （x^-± s） or median （M）. Oneway ANOVA were used to analyze the difference of NT-proBNP and LVEF among different groups. The linear correlation of NT-proBNP and Ross score, and NT-proBNP and LVEF were analyzed. P value less than 0.05 was considered as statistically significant. Results The serum NT-proBNP level in the study group （median 504.3 pg/ml, range from 13.2 to 66664.0 pg/ml） was sigiticanfly higher than that in the the control （ median 94.0 pg/ml, range from 9.1 to 574.0 pg/ml; P 〈0.01）. The eoneentrafion of NT-proBNP in serum was positively eorrelated with modified Ross Score （ r = 0.79, P 〈 0.01 ）, and negatively correlation with LVEF （ r = - 0.42, P 〈 0.01 ） respoetively. Using serum NT-proBNP concentration ≥ 344 pg/ml as the cut point for diagnosing CHF, the sensitivity was 89.7%, the specificity was 90.0%, and the area under the ROC curve was 0.95. Conclusions The concentration of NT-proBNP in serum can be used to diagnose CHF and to assess cardiac function with high sensitivity and specificity in pediatric patients.