血清脑钠肽检测在小儿甲亢性心脏病中的诊断价值

Value of serum brain natriuretic peptide in the diagnosis of hyperthyroid heart disease in children

目的探讨血清脑钠肽(BNP)检测在小儿甲亢性心脏病(甲亢心)中的诊断价值。方法测定并比较甲亢心28例(甲亢心组),甲状腺功能亢进症(甲亢组)及对照组各30例小儿的血清BNP、左室射血分数(LVEF),二尖瓣血流频谱E/A比值等指标,并以BNP为诊断指标,对小儿甲亢心进行诊断试验评价。结果①甲亢心组和甲亢组患儿治疗前血清BNP水平均显著高于对照组(P<0.05),LVEF及E/A比值明显低于对照组(P<0.05),甲亢心组血清BNP水平与TT3、TT4水平呈显著正相关(r=0.801,P<0.05;r=0.578,P<0.05),与LVEF、E/A比值呈显著负相关(r=-0.48,P<0.05,r=-0.35,P<0.05)。②甲亢心组和甲亢组患儿治疗3个月后血清BNP、TT3、TT4显著低于治疗前(P<0.05),LVEF、E/A比值显著高于治疗前(P<0.05)。③以BNP>323.62pg/mL为界点诊断甲亢心的灵敏度为92.86%、特异度90.00%、阳性预测值89.66%、阴性预测值93.10%。结论血清BNP检测是小儿甲亢心比较可靠的诊断指标,其水平的高低结合LVEF、E/A比值可反映甲亢心的严重程度以及心肌损害的程度。

Objective To evaluate the value of serum brain natriuretic peptide（BNP）in the diagnosis of hyperthyroid heart disease in children.Methods Fifty-eight children with hyperthyroidism were assigned to two groups according to their cardiac functions：hyperthyroid heart disease（n=28）and hyperthyroidism alone（n=30）.Thirty healthy children served as the control group.Serum BNP level,left ventricular ejection fraction（LVEE）and E/A ratio were measured before and after treatment.The diagnostic value of BNP was evaluated in children with hyperthyroid heart disease.Results The serum BNP level in the hyperthyroid heart disease and the hyperthyroidism alone groups before treatment was significantly higher than that in the control group（P〈0.05）,while the LVEF and the E/A ratio were significantly lower than those in the control group（P〈0.05）.Serum BNP level was positively correlated with the TT3（r=0.801,P〈0.05）and TT4 levels（r=0.578,P〈0.05）and negatively with the LVEF（r=-0.48,P〈0.05）and the E/A ratio（r=-0.35,P〈0.05）in the hyperthyroid heart disease group.The serum BNP,TT3 and TT4 levels in the hyperthyroid heart disease and the hyperthyroidism alone groups were reduced and the LVEF and the E/A ratio increased significantly three months after treatment（P〈0.05）.When serum BNP level of 〉323.62 pg/mL was proposed as a cutoff point,the sensitivity,specificity,positive predictive value and negative predictive value were 92.86%,90.00%,89.66% and 93.10% respectively for the diagnosis of hyperthyroid heart disease.Conclusions BNP may serve as a reliable marker for the diagnosis of hyperthyroid heart disease in children.Serum BNP level along with the LVEF and the E/A ratio may be useful in the evaluation of the severity and the cardiac function in children with this disease.