新生儿缺氧缺血性脑病合并心肌损伤血浆N端脑利钠肽前体的变化及与预后的相关性

Change and prognosis prediction of N-terminal pro-brain natriuretic peptide in neonates with hypoxic- ischemic encephalopathy complicated with myocardial ischemic injury

目的 探讨N端脑利钠肽前体（NT-proBNP）在缺氧缺血性脑病（HIE）合并心肌损伤患儿中的变化,为临床早期诊断、治疗及预后判断提供依据.方法 选择我院收住的40例HIE患儿为研究对象（心肌损伤16例,非心肌损伤24例）,以20例正常新生儿为对照组,应用ELISA方法测定血浆NT-proBNP水平;超声心动图测定患儿的心脏收缩功能.结果 （1）心肌损伤患儿NT-proBNP水平[（350±56）pmol/L]显著高于非心肌损伤组[（135±37）pmol/L]和正常对照组[（117±23）pmol/L],差异有统计学意义（P＜0.05）;（2）轻、中、重度HIE组NT-proBNP水平分别为（132±34）pmol/L、（247±43）pmol/L和（343±53）pmol/L,中、重度HIE组显著高于对照组;轻、中、重度HIE组间比较差异有统计学意义（P＜0.05）;（3）心肌损伤组急性期血浆NT-proBNP水平[（350±56）pmol/L]明显高于恢复期[（250±78）pmoyl/L],差异有统计学意义（P＜0.05）;（4）HIE患儿NT-proBNP水平和肺动脉收缩压、左室收缩功能密切相关.结论 HIE合并心肌损伤急性期血浆NT-proBNP水平升高,有助于早期诊断心肌损伤,判断HIE病情.

Objective To investigate the changes of N-terminal pro-brain natriuretic peptide （NT-proBNP） in neonates with hypoxic-ischemic encephalopathy （HIE） complicated by myocardial ischemic injury. Methods Forty neonates with HIE （ 16 cases with concurrent myocardial injury and 24 cases without） were enrolled. Twenty healthy neonates were used as control. Plasma NT-proBNP levels were measured using enzyme immunoassay. Cardiac function was measured by echocardiography. Results （ 1 ） The mean plasma NT-proBNP levels in patients with myocardial injury[（350 ± 56） pmol/L]were significantly higher than those in patients without myocardial injury[（135 ± 37 ） pmol/L]and in the control group [（117 ±23） pmol/L]（P 〈0. 05）. （2） The NT-proBNP levels in mild,moderate and severe HIE neonates were （ 132 ±34） pmol/L, （247 ±43） pmol/L and （343 ±53） pmol/L. Compared with the control group,the NT-proBNP levels in the neonates with moderate and severe HIE significantly increased. There were significant differences in the NT-proBNP levels among the mild, moderate and severe HIE neonates （ P 〈 0. 05 ）.（3） In patients with myocardial injury,the NT-proBNP levels significantly decreased in the convalescent phase [（250±78） pmol/L]compared with those in the acute phase[（350±56） pmol/L]（P 〈0.05）. （4） The NT-proBNP levels were significantly related with left ventricular ejection fraction. Conclusion Plasma NT-proBNP levels increase in neonates with HIE complicated with myocardial ischemic injury in the acute phase.Detection of NT-proBNP levels maybe useful in the diagnosis of myocardial ischemic injury and severe HIE.