心型脂肪酸结合蛋白检测联合无创心排血量监测在新生儿败血症心肌损伤诊断中的应用

The diagnostic value of heart fat acid binding protein and ultrasonic noninvasive cardiac output monitoring system in myocardial damage of newborn with neonatal sepsis

目的探讨血清心型脂肪酸结合蛋白(H-FABP)检测联合无创心排血量监测(USCOM)在新生儿败血症心肌损伤诊断中的应用价值。方法本研究纳入新生儿败血症患儿66例,根据肌酸激酶同工酶(CK-MB)水平判断是否合并心肌损伤,其中合并心肌损伤的38例设为观察组,无合并心肌损伤的28例设为对照组。分别于发病后第1天、第5天、第10天采用酶联免疫吸附法检测血清H-FABP及CK-MB水平;采用USCOM行床边动态监测并记录患儿发病后第1天、第3天、第7天左心室输出量(CO)和全身外周血管阻力(SVR)。结果 2组发病后第1天血清H-FABP水平显著高于发病后第5天和第10天(P<0.05),且观察组发病后第1天血清H-FABP水平显著高于对照组(P<0.05);观察组发病后第3天和第7天时左心室CO较发病第1天时显著升高(P<0.05),SVR显著降低(P<0.05);相关性分析显示,观察组发病后第1天血清H-FABP水平与左心室CO呈负相关(r=-0.446,P<0.05),与SVR(r=0.781,P<0.05)和CK-MB呈正相关(r=0.664,P<0.05)。结论血清H-FABP水平能反映新生儿败血症患儿心肌损害的严重程度,联合USCOM动态监测对评估患儿病情及预后具有潜在价值。

Objective To investigate the diagnostic value of heart fat acid binding protein（ H-FABP） and ultrasonic noninvasive cardiac output monitoring（ USCOM） system in myocardial damage of newborn with neonatal sepsis. Methods A total of 66 newborns with neonatal sepsis were selected,in which 38 cases with myocardial damage were selected as observation group and another28 cases without myocardial damage were designed as the control group. The serum levels of H-FABP and creatine kinase isoenzyme-MB（ CK-MB） were detected on first day,fifty day and tenth day after onset of illness. The left ventricular cardiac output（ CO） and systemic vascular resistance（ SVR） on first day,third day and seventh day after onset were recorded by USCOM system. Results The serum level of H-FABP on first day after onset was significantly higher than that on fifth day and tenth day in both groups（ P〈0. 05）,and the level of H-FABP in observation group was significantly higher than controls on first day after onset（ P〈0. 05）. The left ventricular CO increased and SVR decreased significantly on third day and seventh day after onset when compared with those on first day in the observation group（ P〈0. 05）. The serum level of H-FABP on first day after onset was negatively correlated with left ventricular CO（ r =- 0. 446,P〈0. 05）,and was positive correlated with SVR（ r = 0. 781,P〈0. 05） and CK-MB（ r = 0. 664,P〈0. 05）. Conclusion Increased H-FABP mayreflect the early myocardial damage in newborn with neonatal sepsis,and can be jointly used with USCOM system for evaluation and prognosis of neonatal sepsis.