脑钠素与肌钙蛋白Ⅰ在小儿心力衰竭诊断中的应用

Brain natriuretic peptide and cardiac troponinⅠ in diagnosis of pediatric heart failure

目的 探讨脑钠素与肌钙蛋白Ⅰ在小儿心力衰竭诊断中的应用.方法 收集我院2013年1月至2015年8月收治的心力衰竭患儿160例随机分为四组,每组40例,并另选40例健康儿童儿归为非心衰组.其中对四组患儿分别以BNP单独诊断、CYn Ⅰ单独诊断、BNP与CYnⅠ串联诊断与BNP与CYn Ⅰ并联诊断,比较心衰儿童与非心衰患儿各时期BNP与CYn Ⅰ水平与四种诊断方法的诊断效能.结果 心衰组患儿BNP与CYn Ⅰ水平在心衰早期[（633.21±80.24）,（0.135±0.036）]、心衰期[（1 043.87±201.34）,（0.429±0.034）]与恢复期[（874.23± 97.14）,（0.196±0.029）]均显著性高于非心衰组[（90.58±6.72）,（0.042±0.016）,（90.61±6.82）,（0.043±0.014）,（90.16±6.91）,（0.041±0.009）],差异具有统计学意义（P＜0.01）;单独诊断中,BNP诊断特意度（92.31％）较高,误诊率（7.69％）低,CYnⅠ单独诊断敏感度（94.59％）高,漏诊率（5.41％）低;BNP与CYnⅠ并联诊断敏感度（94.87％）、特异度（92.68）、诊断符合率（93.75％）、阳性预测值（92.50％）与阴性预测值（95.00％）最高,漏诊率（5.13％）与误诊率（7.32％）最低;BNP与CYn Ⅰ串联诊断效能最差.结论 脑钠素与肌钙蛋白Ⅰ在小儿心力衰竭诊断具有重大的意义,优先选用BNP与CYnⅠ并联诊断,具有借鉴性.

Objective To investigate the application value of brain natriuretic peptide and cardiac troponin Ⅰ in the diagnosis of pediatric heart failure.Methods 160 patients with pediatric heart failure admitted into our hospital from January, 2013 to August, 2015 were randomly divided into four groups, 40 cases for each group.40 healthy children were selected as a no heart failure group.The 4 heart failure groups were diagnosed with only BNP, with only CYnⅠ, with BNP and CYnⅠ, and with BNP and CYnⅠ.The levels of BNP and CYnⅠ of the heart failure children and no heart failure children in each stage and the diagnosis efficacy of the four diagnostic methods were compared.Results The levels of BNP and CYnⅠ of the heart failure children were （633.21±80.24） and （0.135±0.036） at early heart failure stage, were （1043.87±201.34） and （0.429±0.034）at heart failure stage, and were （874.23±97.14） and （0.196±0.029） at restoration stage, which were all significantly higher than those of the no heart failure children [（90.58±6.72） and （0.042±0.016）, （90.61±6.82） and （0.043±0.014）, and （90.16±6.91） and （0.041±0.009）], with statistical differences （P〈0.01）.In the stand-alone diagnosis, the diagnostic specificity of BNP （92.31%） was higher, the misdiagnosis rate （7.69%） was low;the diagnostic sensitivity of CYnⅠ （94.59%）was high, the rate of missed diagnosis （5.41%）was low;the parallel diagnostic sensitivity （94.87%）, specificity （92.68%）, diagnostic accordance rate （93.75%）, positive predictive value （92.50%）, negative predictive value （95.00%） were the highest and the rate of missed diagnosis （5.13%） and the misdiagnosis rate （7.32%） were the lowest;the diagnostic efficacy of the parallel diagnosis of BNP and CYnⅠ was the worst.Conclusions Brain natriuretic peptide and cardiac troponin Ⅰ have important significance in the diagnosis of pediatric heart failure.First selection of parallel diagnosis of BNP and CYnⅠ is of reference in clinical practice.