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氨基末端脑钠肽和糖原磷酸化酶同工酶脑型对充血性心力衰竭患儿的诊断价值 被引量:9

Value of N-Terminal Pro Brain Natriuretic Peptide and Glycogen Phosphorylase BB for Early Diagnosis in Children with Congestive Heart Failure
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摘要 目的探讨氨基末端脑钠肽(NT-proBNP)、糖原磷酸化酶同工酶脑型(GPBB)在充血性心力衰竭(CHF)患儿中的改变及其与CHF严重程度、肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)的关系,为诊断CHF提供新的、理想的生物学标志。方法选择2006年9月-2007年6月本院住院的由不同心脏疾病[室间隔缺损(VSD)14例,房间隔缺损(ASD)5例,病毒性心肌炎3例,动脉导管未闭、VSD并ASD、扩张型心肌病各2例,法洛四联症1例]引起的CHF患儿29例(CHF组)。均具有典型表现,临床诊断为CHF。采用小儿心力衰竭诊断改良Ross评分系统进行CHF严重程度评分,其中Ross评分≥1分诊断为CHF。随机选择本院同期健康体检婴幼儿和儿童11例作为健康对照组。采用酶联免疫吸附法(ELISA)测定各组NT-proBNP和GPBB水平,同时检测cTnT、CK-MB水平,超声心动图测量左室射血分数(LVEF)。结果CHF组血NT-proBNP、GPBB、cTnT、CK-MB水平均显著高于健康对照组(t=3.46,4.08,3.06,2.73 Pa<0.05)。NT-proBNP、GPBB、cTnT、CK-MB诊断CHF的敏感性分别为75.9%、72.4%、34.5%、58.9%,NT-proBNP、GPBB的敏感性均优于cTnT(χ2=10.04,8.39 Pa<0.05)。NT-proBNP与改良Ross评分、cTnT及CK-MB均具有良好的相关性(r=0.52P<0.05;r=0.69 P<0.05;r=0.74 P<0.01)。结论NT-proBNP、GPBB为诊断小儿CHF提供了新的理想的标志物;联合检测CHF患儿NT-proBNP、GPBB、cTnT、CK-MB的变化可动态观察CHF的发生发展过程,有助于评估小儿CHF的严重程度及心肌损害程度。 Objective To examine the contribution of combined measurements of N - terminal pro brain natriuretic peptide ( NT - proB- NP) and glycogen phosphorylase BB (GPBB)in children with congestive heart failure (CHF) and explore their relationship with clinical symptoms,cardiac troponin T (cTnT) and creatine kinase isoenzyme (CK- MB) in order to find new reliable and objective biochemical markers to diagnose CHF in children. Methods Data were gathered from Sep. 2006 to Jun. 2007 in the affiliated hospital of Luzhou medical college including children with CHF caused by ventricular septal defect ( n = 14 ), atrial septal defect ( n = 5 ), viral myocarditis ( n = 3 ) , pa- tent ductusarterious ( n = 2) ,atrioventricular septal defect ( n = 2), dilated cardiomyopathy ( n = 2) and postoperative tetralogy of Fallot ( n = 1 ). Modified scoring system described by Ross was used to scord clinical heart function. Children with Ross score ≥1 score were regarded as CHF. Eleven healthy infants and children were recruited as control group. The plasma levels of NT - proBNP and GPBB were measured by en- zyme - linked immunosorbent assay (ELISA) , cTnT, CK - MB were detected simultaneously. Left ventricular ejection fraction (LVEF) was measured by ultrasound cardiogram. Results It was noticed that the mean levels of NT - proBNP, GPBB, cTnT and CK - MB in children with CHF were significantly higher than those in control group( t = 3.46,4.08,3.06,2.73 P 〈 0.05 ). The sensitivity of NT - proBNP, GPBB, cTnT and CK - MB for the diagnosis of CHF was 75.9% ,72.4% ,34.5% ,58.9%, respectively. The sensitivity of NT-proBNP and GPBB were siginificant higher than that of cTnT ( ~2 = 10.04,8.39 Po 〈 0.05 ). The level of NT - proBNP showed significantly positively correla- tedwithclinicalheartfailurescore(r=0.52 P〈0.05),cTnT(r=0.69 P〈0.05) andCK-MB(r=0.74 P〈0.01).Conlusions NT- proBNP and GPBB might be new reliable and objective biochemical markers. Combined measurements of NT- proBNP, GPBB, cTnT and CK- MB in children with CHF might reflect the evaluation and development of CHF,and be helpful tools for prognosis the severity of CHF, and the damage of myocardium in children.
出处 《实用儿科临床杂志》 CAS CSCD 北大核心 2008年第13期1008-1010,共3页 Journal of Applied Clinical Pediatrics
基金 泸州医学院附属医院科研课题项目资助(06034)
关键词 脑钠肽 糖原磷酸化酶同工酶 肌钙蛋白 心力衰竭 诊断 brain natriuretic peptide glycogen phosphorylase cardiac troponin heart failure diagnosis
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