风湿性心脏病患儿血浆脑利钠肽水平变化的意义

Significance of Changes of Brain Natriuretic Peptide in Children with Rheumatic Heart Disease

目的观察风湿性心脏病患儿血浆脑利钠肽(BNP)水平的变化,探讨其在风湿热(RF)并心脏病变患儿中的诊断价值。方法选择RF患儿20例(RF组),包括风湿性心脏病患儿11例(心脏病变组),无心脏病变患儿9例(无心脏病变组)。同时选择20例健康儿童作为健康对照组。采用ELISA测定各组血浆BNP、肌钙蛋白I(cTnI)水平,并行心脏彩色多普勒超声及ECG检查。健康对照组随机采血1次,测定血浆BNP和cTnI水平。应用SPSS 11.5软件进行统计学分析。结果 RF组患儿血浆BNP、cTnI水平均明显高于健康对照组(Pa<0.01);心脏病变组血浆BNP水平较无心脏病变组明显升高(P<0.01),cTnI水平二组比较差异亦有统计学意义(P<0.05);BNP异常升高率显著高于cTnI(χ2=14.19,P<0.01)及ECG(χ2=10.23,P<0.01),cTnI异常率与ECG异常率比较差异无统计学意义(χ2=1.37,P>0.05)。心脏病变组患儿BNP与cTnI水平呈显著正相关(r=0.32,P<0.05)。结论BNP在风湿性心脏病患儿中异常增高,与cTnI呈正相关,且较cTnI、ECG灵敏度高。BNP、cTnI二者结合对RF并心脏病变的诊断具有重要意义。

Objective To observe the changes of brain natriuretic peptide（BNP） in children with rheumatic fever（RF） disease,and ex- plore its diagnostic value in rheumatic heart disease. Methods Twenty RF children （RF group） were collected, including 11 patients com- bined with heart disease （ heart disease group） and 9 patients without heart disease （ non - heart disease group） ;Twenty healthy children were obtained as healthy control group. The plasma level of BNP and cardiac troponin I （ cTnI ） were measured by using enzyme - linked immu- nosorbent assay ; Two - dimensional echocardiography and ECG were used for all the patients. The plasma levels of BNP and cTnI were ran- domly measured once in healthy control group. SPSS 11.5 software was used to analyze the data. Results BNP and cTnI were significantly higher in RF group than those in healthy control group（P 〈0. 01 ）. The BNP level was significantly higher in heart disease group than that in non - heart disease group （ P 〈 0.01 ） ; The difference of cTnI level between the 2 groups was significant （ P 〈 0.05 ）. The percentage of patients with increased BNP was significantly higher than that with increased cTnI （X^2 = 14.19 ,P 〈 0. 01 ） and that with abnormal ECG （X^2 = 10.23, P 〈0.01 ） ,while there was no significant difference between the latter two（X^2 = 1.37 ,P 〉 0.05 ）. In heart disease group,the BNP level was significantly positively correlated with cTnI （ r = 0. 32, P 〈 0.05 ）. Conclusions The plasma level of BNP is drastically increased in rheumatic heart disease, and is positively correlated with cTnI ; BNP has higher sensitivity than cTnI and ECG. Detection of plasma BNP and cTnI levels have important clinical significance for diagnosis on rheumatic heart disease.