脑钠肽和氨基末端脑钠肽在小儿先天性心脏病心功能评估中的价值

Values of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide in evaluation of cardiac function in children with congenital heart disease

目的探讨脑钠肽(BNP)和氨基末端脑钠肽(NT-proBNP)在小儿先天性心脏病心功能评估中的价值。方法71例先天性心脏病患儿分为无心力衰竭组和心衰组;35例正常儿童作为对照组。应用微粒子酶免疫分析法和电化学发光法分别测定血浆BNP和NT-proBNP浓度。同时测定左室舒张末期内径指数(LVEDDI)、左室射血分数(LVEF)。结果心衰组血浆BNP和NT-proBNP水平明显高于无心衰组(均P<0.01);无心衰组血浆BNP和NT-proBNP水平明显高于对照组(均P<0.01)。心衰组血浆LogBNP和LogNT-proBNP水平与LVEF均呈负相关(r=-0.64,-0.67,均P<0.01);二者水平与LVEDDI均呈正相关(r=0.58,0.76,均P<0.01)。无心衰组血浆LogBNP和LogNT-proBNP水平与LVEF均无明显相关性;血浆LogNT-proBNP水平与LVEDDI呈正相关(r=0.35,P<0.05)。分别以BNP≥149.8pg/mL,NT-proBNP≥820.1pg/mL作为充血性心力衰竭的诊断阈值,二者的敏感度分别为87.0%,91.3%,特异度分别为91.7%,97.9%,ROC曲线下面积分别为0.935,0.987。结论BNP和NT-proBNP均可用于先天性心脏病患儿心功能的评估,并可用于该类患儿充血性心力衰竭的诊断;与BNP比较,NT-proBNP诊断心衰的价值更高。

Objective To study the values of brain natriuretic peptide （BNP） and N-terminal pro-brain natriuretic peptide （NT-proBNP） in the evaluation of cardiac function in children with congenital heart disease （CHD）. Methods Seventy-one children with CHD were classified to two groups ： congestive heart failure （CHF） （ n = 23 ） and non-CHF （n =48）. Thirty-five age-matched normal children were used as the control group. Plasma BNP content was measured using a microparticle enzyme immunoassay （MEIA） on the AxSYM. Plasma NT-proBNP content was measured using an automated electroehemiluminescence immunoassay on a Roche Modular Analytics E170 analyzer. Echocardiographic parameters, including left ventrieular end diastolic dimension index （LVEDDI） and left ventricular ejection fraction （LVEF）, were measured. Results Plasma BNP and NT-proBNP contents in the CHF group were significantly higher than those in the non-CHF group （ P 〈 0.01 ）. The non-CHF group had higher plasma BNP and NT-proBNP contents than the control group （ P 〈 0.01 ）. LogBNP and LogNT-proBNP values were negatively correlated with the LVEF in the CHF group （r = -0. 64, r = -0.67 respectively, P 〈 0. 01 ）, and they were positively correlated with the LVEDDI （r = 0.58, r = 0.76 respectively, P 〈 0.01 ）. In the non-CHF group, LogBNP and LogNT-proBNP values were not correlated with the LVEF, but a positive correlation was found between the LogNT-proBNP value and the LVEDDI （ r = 0.35, P 〈 0.05 ）. Using plasma BNP content ≥149.8 pg/mL and NT-proBNP content ≥820.1 pg/mL as cut-off values for diagnosing CHF respectively, the sensitivities were 87. 0 % and 91. 3% respectively, the specificities were 91.7% and 97.9% respectively, and the areas under the ROC curves were 0. 935 and O. 987 respectively. Conclusions Both BNP and NT- proBNP can be useful in assessment of cardiac function and diagnosis of CHF in children with CHD. NT-proBNP appears to be more sensitive and specific in the diagnosis of CHF than BNP.