心力衰竭患儿血浆氨基末端B型利钠肽前体检测的临床意义

Clinical Significance of Detection of Plasma Amino-Terminal B-Type Natriuretic Peptide in Children with Heart Failure

目的探讨血浆生物学标志物氨基末端B型利钠肽前体(NT-proBNP)心力衰竭判断指标与改良Ross标准、青岛标准的符合率和相关性,并拟定适合我国国情的小儿心力衰竭联合诊断标准;探讨NT-proBNP在心源性与非心源性呼吸困难诊断的鉴别意义。方法测定2010年3月-2011年9月佛山市顺德区妇幼保健院收治的以改良Ross评分标准诊断的50例小儿心力衰竭患儿(心力衰竭组)、50例非心源性呼吸困难患儿(无心力衰竭组)及50例健康儿童(健康对照组)血浆NT-proBNP水平;并测定心力衰竭治疗后NT-proBNP水平;计算NT-proBNP心力衰竭判断指标与改良Ross标准及青岛标准的符合率;拟定心力衰竭联合诊断标准;确定血浆NT-proBNP在心源性与非心源性呼吸困难诊断的鉴别意义,并进行统计学分析。结果 50例心力衰竭患儿中48例NT-proBNP指标异常升高,心力衰竭NT-proBNP诊断指标与改良Ross心力衰竭诊断标准的符合率为96.0%;轻、中、重度心力衰竭患儿NT-proBNP水平与改良Ross标准有相关性(r=0.675,P=0.000);48例NT-proBNP异常升高的心力衰竭患儿中32例符合青岛心力衰竭诊断标准,符合率为66.67%;无心力衰竭组及健康对照组NT-proBNP检测无一例异常升高,心力衰竭组与无心力衰竭组、健康对照组比较差异有统计学意义(Pa=0.000)。50例心力衰竭患儿经抗心力衰竭治疗后38例NT-proBNP水平降至正常、12例明显下降;治疗前后NT-proBNP指标比较差异有统计学意义(P=0.001)。结论 NT-proBNP可作为心力衰竭诊断的敏感生物学指标物;改良Ross标准与NT-proBNP心力衰竭判断指标符合率高,二者结合可作为心力衰竭联合诊断标准;NT-proBNP检测有助于心源性与非心源性呼吸困难的鉴别诊断。

Objective To explore the accordance rate and correlation of plasmatic amino - terminal B - type natriuretic peptide （ NT - proBNP） level, a biomarker of heart failure, with modified Ross criteria and Qingdao criteria and to investigate a new diagnostic criteria for pe- diatric heart failure. And to explore the differential diagnosis significance of NT - proBNP between cardiogenic and non - cardiogenic dyspnea. Methods The plasma NT - proBNP level was measured in the 50 children diagnosed as heart failure according to the modified Ross criteria as well as 50 children with non - cardiogenic dyspnea and 50 healthy children（ as controls） from Mar. 2010 to Sep. 2011 in Women and Chil- dren＇s Health Hospital of Shunde. The accordance rate of the plasmatic NT - proBNP level with the modified Ross criteria or the Qingdao diag- nostic criteria of China was calculated and drawing up a ＂heart failure joint diagnostic criteria . Determine the clinical significance on cardio- genic and non - cardiac differential diagnosis of dyspnea by detecting NT - proBNP. Results The NT - proBNP level increased dramatically in 48 cases of the 50 children with heart failure and the accordance rate with the modified Ross criteria was 96.0%. The plasma NT - proBNP level elevated following modified Ross score increased in children with mild, moderate, severe heart failure, there was a positive correlation between the two correlation coefficient （r = 0. 675, P = 0. 000）. Only 32 cases of those 48 children accorded with the Qingdao diagnostic criteria of China, and the accordance rate was 66.67%. The NT - proBNP level was normal in the children with non - cardiogenic dyspnea or healthy controls. Significant difference in NT - proBNP levels existed among the 3 groups （ Pa = O. 000 ）. By treatment to 50 cases with heart failure, NT- proBNP of 38 cases to normal, of 12 cases significantly decreased, there was significant difference between before and after treatment （ P = 0. 001 ）. Conclusions The NT - proBNP level is a specific and sensitivity biomarker for the diagnosis of heart failure and the differential diagnosis of dyspnea. New combined diagnostic criteria for heart failure can be made based on both the NT - proBNP level and the modified Ross criteria. The detection of NT - proBNP can be used to differential diagnosis for cardiogenic and non - cardiogenic dyspnea.