氮端B型利钠肽原在早产儿动脉导管未闭诊断中的应用

Diagnostic value of N-terminal pro-B-type natriuretic peptide on haemodynamically significant patent ductus arteriosus in preterm infants

目的探讨氮端B型利钠肽原（NT-pro BNP）在早产儿血流动力学显著的动脉导管未闭（hs PDA）中的诊断价值。方法选取我院新生儿重症监护病房收治的生后6 h内入院的胎龄28-33周早产儿,根据生后第3天的心脏彩超结果和临床症状分为hs PDA组和对照组。分别检测并比较两组生后第1、3天的血NT-pro BNP水平。应用受试者操作特性（ROC）曲线确定NT-pro BNP诊断hs PDA的临界值。结果共纳入46例早产儿,hs PDA组17例,对照组29例。生后第1天,hs PDA组和对照组NT-pro BNP水平差异无统计学意义[（1 980.9±674.5）pmol/L比（1 558.9±713.9）pmol/L,P〉0.05]。生后第3天,hs PDA组NT-pro BNP水平明显高于对照组[（5 697.6±2 113.2）pmol/L比（1 486.9±710.1）pmol/L,P〈0.05],差异有统计学意义。诊断hs PDA的ROC曲线下面积为0.948（95%CI 0.889-1.000,P〈0.05）,以1 850 pmol/L为临界值的灵敏度为100%,特异度为69%;最适临界值为2 150 pmol/L,灵敏度88%,特异度79%。结论生后第3天血NT-pro BNP水平有可能成为诊断早产儿hs PDA的良好指标。

Objective To evaluate the value of plasma NT-pro BNP in diagnosing haemodynamically significant patent ductus arteriosus（ hs PDA） in preterm infants. Methods Preterm infants born at 28 to 33 weeks of gestational age and admitted to neonatal intensive care unit of our Hospital within 6 hours after birth were prospectively enrolled. According to the echocardiography with color Doppler at third day after birth and clinic signs,participants were assigned into hs PDA group and control group. Plasma NT-pro BNP levels were measured and compared between groups on days 1 and day 3. Results Among 46 infant recruited,17 infants were assigned to hs PDA group and 29 infants were assigned to control group. There was no significant difference of NT-pro BNP level on day 1 between two groups [（ 1 980. 9 ± 674. 5） pmol / L vs.（ 1 558. 9 ± 713. 9） pmol / L,P〈0. 05]. On day 3,plasma NT-pro BNP levels of infants in hs PDA group were significantly higher than those of infants in control group [（ 5 697. 6 ± 2 113. 2） pmol / L vs.（ 1 486. 9 ± 710. 1） pmol / L,P〈0. 05]. The area under the ROC curve was 0. 948（ 95% CI 0. 889- 1. 000,P〈0. 05）. NT-pro BNP was predictive of hs PDA at a cut-off value of 1 850 pmol / L（ sensitivity 100%; specificity 69%）,while at the optimal cutoff value of 2 150 pmol / L（ sensitivity 88%,specificity 79%）. Conclusions Plasma NT-pro BNP level on day 3might be a good marker for hsP DA in preterm infants.