脑钠肽在新生儿持续肺动脉高压诊断和治疗中的意义

Significance of Brain-Type Natriuretic Peptide in Diagnosis and Management of Persistent Pulmonary Hypertension in Neonates

目的探讨脑钠肽（BNP）在新生儿持续肺动脉高压（PPHN）诊断和治疗中的临床应用价值,明确BNP是否可以作为判别PPHN的生化定量指标。方法采用前瞻性对照研究,对54例发绀患儿及时行心脏彩色超声Doppler检查,结合临床鉴别出PPHN组29例、non-PPHN组25例,以同期住院无发绀患儿12例作为对照组。应用免疫荧光分析测定66例患儿血清BNP水平,比较各组患儿间BNP水平差异,应用SPSS 13.0统计软件描绘ROC曲线,评价该方法的价值及寻找判断PPHN的最佳临界值。结果 PPHN组新生儿BNP水平[（1 937.40±1 392.36）ng.L-1]显著高于non-PPHN组新生儿[（537.00±731.49）ng.L-1]和对照组[（50.72±36.50）ng.L-1]（F=19.42,P〈0.001）,而non-PPHN和对照组BNP水平比较无统计学意义（P〉0.05）;ROC曲线下面积为0.903,95%可信区间0.818~0.988;判别PPHN的最佳BNP水平为807 ng.L-1,以此为标准,判别PPHN的灵敏度为0.828,特异度为0.880。结论 PPHN新生儿血清BNP水平明显升高,而BNP可作为一种动态观察指标,在判别PPHN的发生及指导合理治疗、判断预后中有重要临床意义。

Objective To investigate the correlation between plasma brain-type natriuretic peptide（BNP） and persistent pulmonary hypertension（PPHN） of the neonates and BNP′s clinical value,and to confirm if BNP levels may be as a biochemistry marker for differentiating PPHN.Methods A prospective control study was conducted to investigate 54 neonates with cyanopathy with cyanopathy by echocardiographic Doppler（ECHO） and other relevant medical check-up was used.All cases were classified into 2 groups by ECHO,PPHN group（n=29）,and non-PPHN group（n=25）.Simultaneously,the third group infants without cyanopathy were assigned as concurrent control（n=12）.BNP levels were measured with a fluorescence immunoassay in plasma samples from 66 patients.The findings were compared and the value was assessed by statistical software SPSS 13.0,and ROC curve was drawn to obtain the best threshold value for discrimination of PPHN.Results BNP level in PPHN group was [（1 937.40±1 392.36） ng·L-1],compared with non-PPHN group[（537.00±731.49） ng·L-1] and control group [（50.72±36.50） ng·L-1] were significantly increased（F=19.42,P0.001）;while there were no difference between non-PPHN and control groups（P0.05）.In this study,the area under the ROC was 0.903.Ninety-five percent confidence interval was 0.818-0.988,so that,if BNP level was 807 ng·L-1,it would serve as a standardization,the sensitivity and specificity for discrimination PPHN was 0.828 and 0.880,respectively.Conclusions The level of BNP in newborns with PPHN is obviously elevated.The level of BNP may be as a dynamic state marker to guide therapy and prognosis and differentiating PPHN.This confirms its significance of clinical value.