先天性心脏病合并心力衰竭患儿血清氨基末端脑利钠肽前体的表达及临床意义

Symptoms and clinical significance of N-Terminal pro-Brain Natriuretic Peptide in children suffering from congenital heart disease combined with heart failure

目的探讨血清氨基末端脑利钠肽前体(NT-proBNP)在先天性心脏病(CHD)合并心力衰竭(HF)患儿中水平变化及临床价值。方法选择2012年4月～2013年2月在浙江省东阳市妇女儿童医院住院CHD患儿120例,根据改良Ross评分法分为两组:无HF组(80例)和HF组(40例),HF组又分为轻度HF组(19例)和中重度HF组(21例),选取同期无CHD和HF儿童作为对照组(50例),通过超声心动图确诊及测量左室射血分数(LVEF)和缩短分数(LVFS);同时对每位患儿进行改良ROSS评分和NT-proBNP检测;应用SPSS 12.0软件统计分析。结果无HF组NT-proBNP[(608.5±102.4)ng/L]高于对照组[(285.6±48.6)ng/L],差异有高度统计学意义(P<0.01);无HF组LVEF、LVFS与对照组比较,差异无统计学意义(P>0.05);HF组及轻度HF组NT-proB-NP、LVEF、LVFS与无HF组比较,差异有统计学意义(P<0.05);轻度HF组NT-proBNP、LVEF、LVFS与中重度HF组比较,差异有统计学意义(P<0.05)。NT-proBNP水平与改良Ross评分心功能分级正相关(r=0.76,P<0.01),与LVEF、LVSF负相关(r=-0.43,P<0.01)。结论 NT-proBNP水平对先天性心脏病合并心力衰竭的早期诊断、病情判断、疗效及预后评估提供了重要的临床价值。

Objective To assess the clinical value of changes of plasma N-Terminal pro-Brain Natriuretic Peptide（NT-proBNP）in children with congenital heart disease（CHD） combined with heart failure（HF）.Methods 120 patients suffering from CHD in Women and Children Hospital of Dongyang City from April 2012 to February 2013 were enrolled.They were divided into 2 groups based on the modified Ross score,no HF group（n = 80）,and HF group（n = 40）.And the HF group was further divided into mild HF group（n = 19） and moderate to severe HF group（n = 21）.50 children without CHD and HF were enrolled as the control group.All patients were diagnosed using echocardiographic and completed the study inculding measurement of left ventricular ejection fraction（LVEF）,left ventricular fractional stortening（LVFS）,and NT-proBNP.In the meantime,the modified Ross score were used to every patient.Statistical analysis of clinical data were performed by using SPSS 12.0 software.Results NT-proBNP in the no HF group [（608.5±102.4） ng/L] was higher than that in the control group [（285.6 ±48.6） ng/L],the differences were statistically significant（P 0.05）,LVEF,LVFS in no HF group were found had no statistically significant differences with control group（P 0.05）;NT-proBNP,LVEF,LVFS in HF group and mild HF group were found had statistically significant differences with no HF group（P 0.05）;NT-proBNP,LVEF,LVFS in mild HF group were found had statistically significant differences with severe HF group（P 0.05）.NT-proBNP was found had positive correlation with modified Ross score（r = 0.76,P 0.01）,while it was found had negative correlation with LVEF,LVSF（r =-0.43,P 0.01）.Conclusions NT-proBNP concentration provides important clinical value for the pediatric patients suffering from CHD and HF in their early diagnosis,judgment,curative effects and prognosis evaluation.