N-末端脑钠素原对小儿支原体肺炎并心肌损害的病情监测

Application of NT-proBNP for the state of illness monitoring in children combined with mycoplasma pneumonia and myocardial damage

目的分析N-末端脑钠素原(NT-ProBNP)对小儿支原体肺炎并心肌损害病情监测的临床意义。方法选择心支原体肺炎并心肌损害患儿62例,采用ROSS心功能分级标准,将患儿分为无心衰组14例,轻度心衰组19例,中度心衰组20例,重度心衰组9例。分别检查4组患儿的NT-ProBNP、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、超敏C-反应蛋白(hs-CRP)及左心射血分数(LVEFE/E)。结果轻度心衰组患儿NT-ProBNP较无心衰组出现显著性升高,差异有统计学意义(P<0.05)。中度心衰组患儿cTnI、hs-CRP较无心衰组显著升高,差异有统计学意义(P<0.05),CK-MB、NT-ProBNP较无心衰组、轻度心衰组相比,差异有统计学意义(P<0.05)。重度心衰组患儿cTnI、CK-MB较无心衰组、轻度心衰组显著升高,差异有统计学意义(P<0.05),hs-CRP较无心衰组显著升高,差异有统计学意义(P<0.05),NT-ProBNP较无心衰组、轻度心衰组、中度心衰组相比,差异有统计学意义(P<0.05)。轻度心衰组患儿LVEF、E/E′较无心衰组相比,差异有统计学意义(P<0.05),中度心衰组患儿LVEF较无心衰组相比,差异有统计学意义(P<0.05),E/E′较无心衰组、轻度心衰组相比,差异有统计学意义(P<0.05)。重度心衰组患儿较无心衰组差异有统计学差异(P<0.05),E/E′较无心衰组、轻度心衰组相比,差异有统计学意义(P<0.05)。NT-ProBNP较cTnI、CK-MB、hs-CRP、LVEF+E/E′对诊断肺炎支原体(MP)感染所致心衰具有更高的灵敏度及特异度。结论 N-末端脑钠素原检测有助于MP感染并心肌损害患儿心衰早期发现与诊断,并有助于判断病情进展。

Objective To analyze the efficacy of terminal pro-brain natriuretic peptide （NT-ProBNP） for the state of illness monitoring in children combined with mycoplasma pneumonia and myocardial damage .Methods 62 children combined with mycoplasma pneumonia and myocardial damage were divided into non-heart failure group （14 cases） ,mild heart failure group （19 cases） ,moderate heart failure group （20 cases） and severe heart failure group （9 cases） ,according to ROSS cardiac functional grading standards .NT-proBNP ,cardiac troponin I （cTnI） ,creat-inkinase isoenzyme MB （CK-MB） ,high-sensitive Creaction protein （hs-CRP） and left ventricular ejection fraction （LVEF） and ratio of early diastolic flow velocity at mitral valve and Mitral annular early diastolic myocardial velocity （E/E′） were examined .Results NT-ProBNP level in mild heart failure group was significantly higher than non-heart failure group （P〈0 .05） .cTnI and hs-CRP levels in moderate heart failure group were higher than non-heart failure group （P〈0 .05） ,and levels of CK-MB and NT-ProBNP were significantly different with those in non-heart failure group and mild heart failure group （P〈 0 .05） .cTnI and CK-MB levels in severe heart failure group were higher than non-heart failure group and mild heart failure group （P〈0 .05） ,hs-CRP level was higher than non-heart failure group （P〈0 .05 ） ,and NT-ProBNP level was higher than non-heart failure group ,mild heart failure group and moderate heart failure group （P〈0 .05） .LVEF and E/E levels in mild heart failure groups were different with those in non-heart failure group （P〈0 .05） .LVEE level in moderate heart failure group was different with that in non-heart failure group （P〈 0 .05） ,and E/E′ level was different with non-heart failure group and mild heart failure group （P〈0 .01 ,P〈0 .05） .E/E′level in severe heart failure groups was different with non-heart failure group and mild heart failure group （P〈0 .05） .NT-ProBNP was more sensitive and specific for the diagnosis of heart failure caused by Mycoplasma pneumoniae （MP） infection than cTnI ,CK-MB ,hs-CRP and LVEF＋E/E′.Conclusion NT-ProBNP might be helpful for the early diagnosis and illness state judgment of heart failure in children combined with MP infection and myocardial damage .