血浆N末端脑钠素原对儿童急性肺损伤和急性呼吸窘迫综合征的早期诊断价值

Early diagnosis value of N-terminal pro-brain natriuretic peptide in children with acute lung injury/acute re- spiratory distress syndrome

目的研究血浆N末端脑钠素原（NT—pro—BNP）对儿童急性肺损伤（Au）和急性呼吸窘迫综合征（ARDS）的早期诊断价值及对预后的影响。方法选取52例ALI／ARDS患儿作为试验组，同期36例心源性疾病并呼吸困难患儿作为对照组。检测试验组患儿肺损伤评分（LIS）、小儿危重病例评分（PCIS）及28d生存状况，比较2组NT．pro。BNP水平及不同病情及预后ALI／ARDS患儿间NT—pro—BNP水平的差异。结果试验组ALI／ARDS患儿血浆NT．pro．BNP水平明显高于对照组（P〈0．05），而对照组发生肺水肿的心源性疾病患儿NT—pro—BNP水平则高于试验组ALI／ARDS患儿（P〈0．05）；28d内死亡患儿、LIS〉2．5分患儿及PCIS≤70分患儿NT—pro—BNP水平分别高于存活患儿、LIS≤2．5分患儿及PCIS〉70分的患儿（P=0．001、0．013、0．002），NT—pro—BNP水平与28d生存状况和LIS呈正相关，与PCIS呈负相关（P均〈0．05）。结论NT—pro—BNP水平的检测有助于ALL／ARDS患儿病情严重程度的判断和预后评估。

Objective To study the early diagnostic value of N-terminal pro-brain natriuretic peptide （NT- pro-BNP） for acute lung injury/acute respiratory distress syndrome （ALI/ARDS） in children and its influence on prog- nosis. Methods Fifty-two children with ALI/ARDS were selected as the experiment group, and 36 children with car- diac disease merging dyspnea were selected as the control group. The serum levels of NT-pro-BNP were measured in the 2 groups. The pediatric critical illness score（PCIS） ,lung injury score （LIS） and 28-day mortality were analyzed in the experiment group. The serum level of NT-pro-BNP, and the different condition and prognosis were compared in 2 groups, and the difference of the NT-pro-BNP levels were compared in children with ALI/ARDS. Results The NT-pro- BNP levels in experiment group were significantly higher than the control group （ P 〈 0.05 ）. But the NT-pro-BNP levels in children with cardiaogenic pulmonary edema were significantly higher than ALI/ARDS（ P 〈 0.05 ）. The NT-pro-BNP levels of the children who died in 28 d, or with LIS 〉 2.5 scores or PCIS ~〈70 scores were higher than that of children who were survived,or with LIS ~〈2.5 scores or PCIS 〉 70 scores （P = 0. 001,0. 013,0. 002 ）. The NT-pro-BNP levels were negatively correlated with PCIS（ P 〈 0.05 ） , and the NT-pro-BNP levels were positively correlated with the 28-day mortality and LIS （ all P 〈 0.05 ）. Conclusions The measurement of serum NT-pro-BNP can help to evaluate the se- verity and prognosis of ALl/ARDS children.