血浆N端B型脑钠肽水平在脓毒症合并心肌损伤患儿中的临床诊断价值

The clinical value of N-terminal pro brain natriuretic peptide in septic children with myocardial damage

目的 本研究旨在探讨N端B型脑钠肽（N-terminal pro brain natriuretic peptide,NT-proBNP）在脓毒症合并心肌损伤患儿中的临床诊断价值.方法 将2013年1月1日至6月30日入住我院PICU的162例确诊脓毒症的患儿按照是否发生心肌损伤分为非心肌损伤组和心肌损伤组,其中心肌损伤组61例（37.65％）,非心肌损伤组101例（62.35％）,入院24 h内对162例脓毒症患儿进行NT-proBNP、乳酸脱氢酶、肌酸激酶同工酶（CK-MB）、肌钙蛋白Ⅰ（cTnⅠ）、肌红蛋白（MB）等检测,比较心肌损伤组与非心肌损伤组间NT-proBNP值,分析NT-proBNP与CK-MB、cTnⅠ、MB的相关性.结果 心肌损伤组NT-proBNP水平[M（Q）,3 632（668.5,15 453.5） pg/ml]高于非心肌损伤组[349（169,1 500） pg/ml],差异有统计学意义（Z=91.881,P=0.000）.NT-proBNP、CK-MB、cTnⅠ、MB为非正态分布资料,经对数转换后进行相关分析,logNT-proBNP与logCK-MB（r=0.367,P=0.000）、logcTnⅠ（r =0.304,P=0.001）、logMB（r=0.302,P=0.000）均呈正相关.以NT-proBNP≥1 163 pg/ml为截断点诊断心肌损伤,敏感性76％,特异性74％.结论 NT-proBNP可用来帮助诊断脓毒症合并心肌损伤.

Objective To evaluate the clinical value of N-terminal pro brain natriuretic peptide （NT-proBNP） in septic children with myocardial damage.Methods From Jan 1 to Jun 30,2013,162 children confirmed with sepsis in PICU of Hu＆#39;nan Children＆#39;s Hospital were enrolled in the study.Patients were divided into myocardical injury and non-myocardical injury group according to whether accompanied with myocardial injury.NT-proBNP,lactate dehydrogenase,creatine kinase isoenzyme （CK-MB）,troponin Ⅰ （cTnⅠ）,myoglobin（MB） of patients were measured within 24 h after admission.The NT-proBNP level between two groups was compared.The correlations between NT-proBNP and cTnⅠ,CK-MB were studied respectively.Results The NT-proBNP level[M（Q）] in myocardial injury group[3 632 （668.5,15 453.5） pg/ml] was higher than that in non-myocardial injury group[349 （169,1 500） pg/ml],which was significantly different（Z =91.881,P =0.000）.The levels of NT-proBNP,CK-MB,cTnⅠ,MB were abnormal distributions.There were positive correlations between logNT-proBNP and logCK-MB （r =0.367,P =0.000）,logcTnⅠ（r =0.304,P =0.001） and logMB （r=0.302,P =0.000）.NT-proBNP value of 1 163 ng/ml had a sensitivity of 76% and a specificity of 74% to diagnose myocardial injury.Conclusion NT-proBNP could help to diagnose sepsis with myocardial damage.