血浆氨基末端脑钠肽在急诊患儿心脏疾病预测中的价值

The value of NT-BNP in assessment of children with heart disease in emergency

目的:探讨血浆氨基末端脑钠肽(NT-proBNP)水平在急诊患儿心脏疾病预测中的价值。方法:采用病例-对照和快速定量检测卡对2011年1月至2012年7月期间收住我院急诊科的59例心脏疾病患儿(心脏病组,其中先天性心脏病组37例,获得性心脏病组22例)和30例非心脏疾病对照组患儿进行血浆NT-proBNP的检测,比较各组之间血浆NT-proBNP水平是否存在差异。同时应用受试者工作特征(ROC)曲线下面积评价血浆NT-proBNP水平在预测急诊患儿心脏疾病中的价值。结果:心脏病组患儿平均血浆NT-proBNP含量为(2 447.83±1 878.84)pg/mL,对照组患儿平均血浆NT-proBNP含量为(438.87±359.49)pg/mL。心脏病组血浆NT-proBNP含量明显高于对照组,差异具有统计学意义(P<0.01)。先天性心脏病组平均血浆NT-proBNP含量为(2 532.19±2 032.98)pg/mL,获得性心脏病组平均血浆NT-proBNP含量为(2 305.95±1 621.99)pg/mL,两组比较差异无统计学意义(P=0.659)。心脏病组患儿X线胸片显示心胸比与血浆NT-proBNP含量呈正相关,相关系数为0.503。血浆NT-proBNP的ROC曲线下面积为0.907(95%可信区间为0.848～0.966)。当NT-proBNP诊断界值为851.5 pg/mL时,约登指数最大,为0.714,灵敏度为0.814,特异度为0.90,此时阴性预测值为0.73,阳性预测值为0.942,OR值为44。结论:血浆NT-proBNP水平对是否患有心脏疾病具有较好的预测能力,但不能区分是先天性心脏病还是获得性心脏病。

Objective： To explore the value of N-terminal pro-brain natriuretic peptide （NT-BNP） in assessment of children with severe heart disease. Methods： From January 2011 to July 2012, 59 cases of children with heart disease, of which 37 cases of congenital heart disease and 22 cases of acquired heart disease, and 30 patients with respiratory or other infectious diseases as control group were chosen for the plasma NT-proBNP inspection using the rapid quantitative detection card. Then, the plasma NT-proBNP levels were compared to see whether there was a significant difference among these groups. At the same time, the receiver-operating characteristic （ROC） curve was used to evaluate the value of the plasma NT-proBNP levels in predicting children with heart disease. Results： The plasma NT-proBNP in the cardiac disease group was obviously higher than that of control group （P〈0.01）. While the average plasma NT-proBNP content of congenital heart disease group was similar to that of acquired heart disease group, and there is no statistical significance between the two groups （P=0.659）. The X-ray showed that the cardiothoracic ratio of children with heart disease was also positively correlated with plasma NT-proBNP, with a correlation coefficient of 0.503. Plasma NT-proBNP area under ROC curve was 0.907 （95% ci 0.848 - 0.966）. Conclusion： NT-proBNP has good ability in predicting children suffered from heart disease.