联合检测氨基末端脑钠肽和肌钙蛋白T在儿童心力衰竭诊断中的意义

Both cardiac troponin T and N-terminal pro-brain natriuretic peptide in children with heart failure

目的评估氨基末端脑钠肽(NT-proBNP)和肌钙蛋白T(CTnT)对小儿心力衰竭(HF)的诊断价值。方法选择平均年龄为1.72岁(31d～12岁)、临床诊断为HF的患儿52例,检测NT-proBNP和CTnT浓度,同时行超声心动图检测左室射血分数(LVEF);16例平均年龄为1.75岁(31d～12岁)的健康儿童为正常对照组;采用Medcalc软件包进行受试者工作特性曲线(ROC)分析。结果HF组NT-proBNP为(255.41±233.96)fmol/ml,显著高于正常对照组(125.80±59.51)fmol/ml(P<0.05);并与CTnT呈显著正相关(P<0.001),与LVEF无相关性(P>0.05)。NT-proBNP以≥141.12fmol/ml为截点,诊断HF的敏感性73.1%,特异性80%;CTnT≥0.01ng/ml诊断HF的敏感性33%,特异性100%。19例CTnT≥0.01ng/ml的HF患儿NT-proBNP水平为(376.20±344.18)fmol/ml,33例CTnT<0.01ng/ml的NT-proBNP为(183.86±83.4)fmol/ml,两者差异有统计学意义(P<0.05)。NT-proBNP以≥190.17fmol/ml为截点,诊断HF并CTnT≥0.01ng/ml的敏感性76.2%,特异性77.4%,ROC曲线下面积0.78(95%可信区间:0.64～0.88,P<0.001)。结论联合检测NT-proBNP与CTnT对于HF合并心肌损伤、心功能不全的诊断具有重要的意义。

Objective To evaluate the diagnostic values of N-terminal pro-brain natriuretic peptide （NT-proBNP） and cardiac troponin T （CTnT） in children with heart failure （HF）. Methods The blood levels of NT-proBNP and CTnT were determined in 52 HF children, aged from 31 days to 12 years （mean 1.72 years old）. Their left ventricular ejection fraction （LVEF） was also measured by ultrasonic cardiogram. Sixteen healthy children were chosen as controls, with age ranged from 31 days to 12 years （mean 1.75 years old）. Data was analyzed by means of receiver operation characteristic curve （ROC）. Results The levels of NT-proBNP of HF group was significantly higher than that of the control group （255.41 ± 233.96 fmol/ml vs 125.80 ± 59.51 fmol/ml, P 〈 0.05）. The levels of NT-proBNP had a positive correlation with CTnT in HF （P 〈 0.001） but had no relationship with LVEF （P 〉 0.05）. If 141.12 fmol/ml of NT-proBNP is used as a cut point, it had a 73.1% sensitivity and a 80% specificity for detecting HF. If 0.01ng/ml of CTnT used as a cut point, it had a 33% sensitivity and a 100% specificity for detecting HF. The levels of NT-proBNP among children with CTnT concentrations above 0.0t ng/ml （n = 19） were significantly higher than that of children with CTnT concentrations below 0.01 ng/ml （n = 33） in HF group （P 〈 0.05）. If both 190.17 fmol/ml of NT-proBNP and /〉 0.01 ng/ml of CTnT used as a cut point, it had a 76.2% sensitivity and a 77.4% specificity for detecting HF with area under ROC curve being 0.78 （95% CI： 0.64 ± 0.88, P 〈 0.001）. Conclusions Measurement of both NT-proBNP and CTnT had important value for the diagnosis of HF in children.