血浆N端脑钠肽原对新生儿窒息后心力衰竭的价值评估

The Value of Plasma N-Terminal Pro-Brain Natriuretic Peptide in the Evaluation of Heart Failure after Neonatal Asphyxia

目的:探讨血浆氨基末端脑钠肽原(NT-proBNP)对新生儿窒息后心力衰竭(HF)的诊断价值。方法:选取2014年1月至2015年3月在我院接受治疗的新生儿窒息患者120例,根据有无HF分为HF组55例和无HF组65例。测定两组患儿血浆NTproBNP、肌钙蛋白I(cTnI)、乳酸脱氢酶1(LDH1)、肌酸激酶同功酶(CK-MB)水平。结果:HF组NT-proBNP、LDH1、CK-MB和cTnI水平分别为27 944.73(18 042.12,30 981.10)ng/L、(463.29±54.29)U/L、192.04(62.74,223.16)U/L和0.12(0.04,0.21)mg/L,明显高于无HF组,差异有统计学意义(P<0.05);非条件Logistic回归分析结果显示,NT-proBNP是新生儿窒息后发生HF的独立危险因素(OR=1.482,P<0.05);NT-proBNP诊断新生儿窒息后发生HF的ROC曲线下面积为0.952,95%CI(0.908,0.995);当截断值为13 181 ng/L时,诊断灵敏度为90.20%,特异性为100%。结论:血浆NT-proBNP对新生儿窒息后心力衰竭有一定诊断价值,对于早期发现窒息后心力衰竭、指导治疗有重要的临床意义。

Objective： To investigate the value of plasma N-terminal pro-brain natriuretic peptide（ NT-proBNP） in the evaluation of heart failure after neonatal asphyxia. Methods： From January 2014 to March 2015 in our hospital,120 cases of neonatal asphyxia according to heart failure（ HF） were divided into HF group（ 55 cases） and non-HF group（ 65 cases）. The levels of NT-proBNP,troponin I（ cTnI）,lactate dehydrogenase 1（ LDH1）,creatine kinase isoenzyme（ CK-MB） were detected in two groups. Results： The levels of NT-proBNP,LDH1,CK-MB and cTnI were 27,944.73（ 18 042.12,30 981.10） ng / L,（ 463.29± 54.29） U / L,192.04（ 62.74,223.16） U / L and 0.12（ 0.04,0.21） mg / L in HF group,those were significantly higher than non-HF group,the differences were statistically significant（ P〈0.05）. Non conditional logistic regression equation showed that NT-proBNP was the occurrence of HF after neonatal asphyxia independent risk factor（ OR = 1.482,P〈0.05）. NT-proBNP diagnosis of neonatal asphyxia area under the ROC curve for HF was 0. 952,95% CI（ 0. 908,0. 995）. When the cutoff value was 13,181 ng / L,the diagnostic sensitivity was 90. 20% and specificity was 100%. Conclusion： Plasma NT-proBNP has a certain value in the diagnosis of heart failure after neonatal asphyxia,for early detection of asphyxia combined with heart failure,guiding treatment,has important clinical significance.