脑钠肽对新生儿窒息后心肌损伤诊断的临床研究

A clinical study of the brain natriuretic peptide in the diagnosis of myocardial injury after neonatal asphyxia

目的探讨血浆脑钠肽(BNP)水平与新生儿窒息后心肌损伤之间的关系。方法选取武汉大学中南医院新生儿科2012年12月至2013年12月收治的窒息患儿,按就诊顺序编号,每间隔1例纳入观察组1例,按照是否有心肌损伤分为心肌损伤组和非心肌损伤组,同时选取同期收治的无窒息史及心血管系统疾病的新生儿为对照组,除外水电解质紊乱和肝肾功能障碍,两组患儿均要求入院日龄<3天。对所有入选患儿在入院2 h内及入院第14天测定血浆BNP、肌酸激酶同工酶(CK-MB)、血钙及血钠等并进行统计分析。结果收集了107例窒息儿,其中77例有完整资料,入选为窒息观察组,其中心肌损伤组36例,非心肌损伤组41例,对照组共入选29例。经log转换后,入院2 h内心肌损伤组血浆BNP水平明显高于非心肌损伤组及对照组[(2.35±0.44)比(2.12±0.64)、(1.88±0.27)],非心肌损伤组高于对照组,差异有统计学意义(P<0.05)。窒息患儿血浆BNP与CK-MB成正相关(r=0.212,P=0.030)。心肌损伤患儿经过治疗,入院第14天时血浆BNP水平较入院2 h内明显下降,差异有统计学意义(P<0.05)。心肌损伤患儿BNP的cutoff值为108.05 pg/ml时,ROC曲线下面积为0.753,敏感度75.0%,特异度64.5%,阳性预测值56.4%,阴性预测值72.3%。结论血浆BNP水平能反映窒息患儿心肌损伤情况,对指导治疗具有重要的临床意义。

Objective To investigate the relationship between serum plasma brain natriuretic peptide （BNP） levels and myocardial injury in neoborns after asphyxia. Methods Neoborns who were admitted to Department of neonatology, Zhongnan Hospital, Wuhan University from December 2012 to December 2013 within 3 days after birth were considered. According to the number organized in chronological order every other case, newborns with neonatal asphyxia were assigned to observation group. The observation group were further divided into myocardial injury subgroup and non-cardiac injury subgroup according to the diagnostic criteria of myocardial injury. Newborns without neonatal asphyxia or neonatal cardiovascular diseases were assigned to control group. Exclusion criteria for control group were electrolyte disturbance, liver and kidney dysfunction. Blood sample was drawn from patients within 2 hours of admission to hospital and again on day 14. Serum BNP, creatine kinase isoenzyme （CK-MB） , serum sodium and calcium were detected for further analysis. Results In 107 cases with neonatal asphyxia, 77 infants who had complete clinical records were selected as observation group, of which 36 met the diagnostic criteria of myocardial injury and assigned to myocardial injury subgroup. Non-cardiac injury subgroup consisted of the rest 41 cases in observation group. Twenty-two cases were enrolled to control group. Within 2 hours after admission, the serum BNP level of myocardial injury subgroup were significantly higher than those of the non-cardiac injury subgroup and the control group （ 2. 35 ± 0. 44, 2. 12 ±0. 64, 1.88 ± 0. 27, log transformed, respectively, P 〈 0. 05）. The BNP level of non-cardiac injury subgroup were also significantly higher than those of the control group. Serum BNP and CK-MB levels of observation group were positively correlated （ r = 0. 212, P = 0. 030 ）. After treatment, serum BNP level of myocardial injury subgroup at 14 days after admission decreased significantly, compared to the level at 2 hours within admission （ P 〈 0. 05 ）. When the cutoff value for infants with myocardial injury was 108.05 pg/mL, the area under the ROC curve was 0. 753, with a sensitivity of 75.0% and a specificity of 64. 5%, positive predictive value was 56.4% and negative predictive value was 72.3%. Conclusions Serum BNP level can reflect myocardial injury in neonates with asphyxia and can guide clinical treatment.