血浆B型氨基端利钠肽原对新生儿窒息后心力衰竭的诊断价值研究

Value of plasma N terminal brain natriuretic peptide in the diagnosis of heart failure after neonatal asphyxia

目的探讨血浆B型氨基端利钠肽原(NT-proBNP)对新生儿窒息后心力衰竭的诊断价值。方法2014年1月至2015年3月平凉市人民医院儿科病房收治的窒息新生儿120例,根据有无心力衰竭分为心力衰竭组55例和无心力衰竭组65例。测定两组患儿NT-proBNP、心肌钙蛋白I(cTnI)、乳酸脱氢酶1(LDH1)、肌酸激酶同功酶(CK-MB)等。结果心力衰竭组NT-proBNP、LDH1、CK-MB和cTnI显著高于无心力衰竭组,差异有统计学意义(P<0.05);非条件性Logistic回归方程结果显示NT-proBNP是新生儿窒息后发生心力衰竭的独立危险因素(OR=1.482,P<0.05);NT-proBNP诊断新生儿窒息后发生心力衰竭的ROC曲线下面积为0.952,95%CI为0.908~0.995,P<0.05;当截断值为13 181ng/L水平时,诊断灵敏度为90.20%,特异性为100.00%;三元线性回归分析显示LDH1和cTnI对NT-proBNP水平有影响,回归方程为NT-proBNP=-403.29+2.20×LDH1+271.04×cTnI。结论血浆NT-proBNP对新生儿窒息后心力衰竭有一定诊断价值,对于早期发现窒息并心力衰竭、指导治疗有重要的临床意义。

Objective To investigate the value of plasma N terminal brain natriuretic peptide（NTproBNP） in the diagnosis of heart failure after neonatal asphyxia. Methods A total of 120 neonates with asphyxia treated in our hospital from Jan. 2014 to Mar. 2015 were divided into two groups according to whether they had heart failure： group A（55 cases of neonates with heart failure） and group B（65 cases without heart failure）. NT-proBNP, cardiac troponin（cTnI）,lactate dehydrogenase（LDHl ） and creatine kinase isoenzyme（CK-MB） were detected in the two groups. Results NT-proBNP, LDH1 , CK-MB and cTnI were significantly higher in group A than in group B, the difference being of statistical significance（P〈0.05）. Unconditioned Logistic regression equation showed that NT-proBNP was the independent risk factor of developing heart failure after neonatal asphyxia（OR= 1. 482, P〈0.05）. The area under ROC curve for heart failure in asphyxia neonates diagnosed by NT-proBNP was 0. 952,95 %CI 0. 908-0. 995 （P〈0.05）. When the cut off value was （13 181 ng/L, the sensitivity of diagnosis was 90. 20% and the specificity was 100. 00%. Three-element linear regression analysis showed that LDH1, and cTnI had influence on NT-proBNP level, and the regression equation was NT-proBNP=-403.29＋2.20X LDH1 ＋271.04X cTnI. Conclusion Plasma NT-proBNP has some value in the diagnosis of heart failure after neonatal asphyxia, which is of great significance in early detection of heart failure and guiding the treatment.