布洛芬口服液治疗早产儿动脉导管未闭中血浆N末端脑利钠肽的变化及意义

Changes and Clinical Significance of Serum N-terminal Brain Natriuretic Peptide Level in the Treatment of Preterm Infants with Patent Ductus by Ibuprofen

目的 探讨血浆N末端脑利钠肽（N-terminal brain natriuretic peptide,NT-proBNP）在早产儿动脉导管未闭（patent ductus arteriosus,PDA）布洛芬口服液治疗前后的变化及意义。方法 选取2013年1月1日～12月31日入笔者医院治疗的90例胎龄28～ 36周的早产儿,在生后72h取血测定血浆NT-proBNP水平,并行心脏超声心动图检查.根据超声心动图结果及有无临床症状分为症状性PDA组（26例）、无症状性PDA组（10例）和对照组（54例）.症状性PDA组患儿接受布洛芬口服液治疗.于生后7天复查症状性PDA组和无症状性PDA组中NT-proBNP水平及心脏超声心动图了解PDA变化情况.统计学方法采用单因素方差分析、SNK-q检验X2检验、Pearson相关分析.结果 生后72h,症状性PDA组和无症状性PDA组的NT-proBNP水平均高于对照组（P＜0.05）,且NT-proBNP水平与PDA管径呈正相关（r=0.649、P＜0.05）,另症状性PDA组NT-proBNP水平也高于无症状性PDA组（P＜0.05）;生后7天,症状性PDA组中：治疗成功的20例PDA患儿NT-proBNP水平较治疗前显著降低,差异有统计学意义（P＜0.05）;治疗失败的6例PDA患儿NT-proBNP水平与治疗前相比差异无统计学意义（P＞0.05）.无症状性PDA组：自然关闭的8例PDA患儿NT-proBNP水平较前降低,差异有统计学意义（P＜0.05）,未关闭的2例PDA患儿NT-proBNP水平与之前相比差异无统计学意义（P＞0.05）.结论 PDA患儿存在NT-proBNP分泌的增加,NT-proBNP水平的动态变化与PDA病情程度相平行,故动态监测NT-proBNP水平可协助超声心动图进行PDA的早期诊断和及时干预。

Objective To investigate the changes and clinical significance of serum N-terminal brain natriuretic peptide level in the treatment of preterm infants with patent ductus by ibuprofen.Methods From 1 January、2013 to 31 December 2013,90 preterm infants with gestationa 1age from 28 to 36 weeks accepted echocardiography examination,and their blood samples were collected to determine N-terminal brain natriuretic peptide levels in the 72 h after deliveries.All subjects were divided into three groups according to the echocardiogram results and the symptomatic：control group （n =54）,symptomatic PDA group （n =26） and no symptomatic PDA group （n =10）.The infants with Symptomatic PDA were treated with ibuprofen.Then echocardiography was taken and NT-proBNP levels were re measured in the 7th day after deliveries.Oneway Anova,SNK-q test,Chi-square test,Pearson correlation analysis were perfomed for statistical analysis.Results In the 72 h after deliveries,NT-proBNP level of Symptomatic PDA group and symptomatic PDA group were significantly higher than the control group （P 〈 0.05,respectively）,and NT-proBNP level was positively correlated with the duct of PDA （r =0.649,P 〈 0.05）,NT-proBNP level of Symptomatic PDA group were higher than the symptomatic PDA group （P 〈 0.05）.In the 7d after deliveries,in Symptomatic PDA group,for twenty infants with successful treatment,NT-proBNP levels decreased markedly,respectively （P 〈 0.05） compared with those levels before treatment.For the six infants failed to close ductus,the NT-proBNP levels were 1 ower than those before treatment （P 〉 0.05）.In symptomatic PDA group,For eight infants with spontaneous closure,NT-proBNP levels decreased markedly,respectively （P 〈 0.05） compared with those levels before.For the two infants failed to spontaneous closure,the NT-proBNP levels were 1ower than those before treatment （P 〉 0.05）.Conclusion PDA could cause the increased secretion of NT proBNP in preterm infants.The changes of blood NT-proBNP were consistent with the severity of PDA.Serial measurements of blood NT -proBNP together with echocardiography might help to make early diagnosis and treatment for premature infants with PDA.