氨基末端B型利钠肽前体评估婴儿期左向右分流型先天性心脏病心功能的价值

Amino terminal B-type natriuretic peptide precursor relevance to modified Ross score and evaluation the value of left to right shunt congenital heart disease cardiac function

目的探讨左向右分流型先天性心脏病(congenital heart disease,CHD)患儿合并心力衰竭时血浆氨基末端B型利钠肽前体(amino terminal B-type natriuretic peptide precursor,NT-pro BNP)变化及其在心功能评价中的价值,分析其与改良Ross评分之间的相关性,寻找小儿心力衰竭时快速检测手段。方法研究对象为1个月~1岁的婴儿,实验组为55例左向右分流型CHD患儿,按照改良Ross评分标准分为4组,治疗前后进行对照。另选12名无CHD及心力衰竭的患儿作为对照组。采用美国(罗氏)快速心力衰竭诊断仪测定患儿血浆NT-pro BNP水平,分析其变化意义,采用SPSS 17.0统计学软件进行统计分析,多组间比较用F检验,通过ROC曲线图,得到诊断截断值。结果 NT-pro BNP与改良Ross评分成正相关(r=0.859),CHD患儿NT-pro BNP水平明显高于对照组,差异有统计学意义(P<0.05),各心力衰竭分组之间差异存在统计学意义(P<0.05)。心力衰竭患儿治疗后,血浆NT-pro BNP明显下降,差异有统计学意义(P<0.001),NT-pro BNP诊断心功能不全的截断值为286.5 pg/ml(95%CI 0.571~0.955)。结论不同程度心力衰竭患儿NT-pro BNP之间存在明显差异,血浆NT-pro BNP可作为婴儿期左向右分流型CHD合并心力衰竭时心功能评估的一个客观指标。

Objective To study the left to right shunt congenital heart disease （congenital heart diseases, CHD） in children with heart failure when plasma amino-terminal B-type Natriuretie Peptide Precursor （ Amino Terminal B-type Natriuretie Peptide, NT-proBNP） changes and its value in the evaluation of cardiac function, analyze the correlation with modified Ross score,search for pediatric heart failure rapid detection methods. Methods The object of study is 55 cases left to fight shunt CHD patients. According to the modified Ross score, the patients were divided into four groups, and the before and after treatment were compared. An alternate 12 cases in the same period in the hospital without CHD and heart failure in children as control group. With the United States（Roche） rapid heart failure diagnosis instrument determination of all children with plasma NT-proBNP level, analyze its significance. Results The NT-proBNP and modified Ross score into positive correlation（ r = 0. 859 ） , the children with CHD NT-proBNP level obviously higher than that of control group, with statistical significance（ P 〈 0.05 ）, there were significant difference among heart failure group （P 〈 0.05 ）. Children with heart failure after treatment, plasma NT-proBNP levels significantly decreased, with statistical significance （ P 〈 0. 001 ）, the NT-proBNP in the diagnosis of cardiac insufficiency of cutoff value was 286.5 pg/ml. Conclusion Different degree of heart failure in children with NT-proBNP have a significant difference, the plasma NT-proBNP can be used as the infant left to fight shunt CHD with heart failure an objective indicator of cardiac function evaluation.