血浆NT-proBNP及H-FABP联合检测在小儿重症肺炎合并心力衰竭中的应用价值

Value of Combined Detection of Plasma NT-ProBNP and H-FABP in Diagnosis of Infants with Severe Pneumonia Associated by Heart Failure

目的探讨N末端脑钠肽前体(NT-proBNP)及心型脂肪酸结合蛋白(H-FABP)联合检测对小儿重症肺炎合并心力衰竭的诊断价值。方法选择2014年8月—2015年8月小儿重症肺炎396例,根据是否合并心力衰竭分为单纯肺炎组356例和肺炎合并心力衰竭组40例,并选择同期健康体检儿童200名为对照组。检测3组血浆NTproBNP、H-FABP水平及左心室射血分数(LVEF)。将肺炎合并心力衰竭组按心功能分为轻、中、重度,观察不同心力衰竭分级患儿血浆NT-proBNP、H-FABP及LVEF变化。NT-proBNP、H-FABP单独和联合检测对小儿重症肺炎合并心力衰竭诊断效果,并分析血浆NT-proBNP及H-FABP水平与LVEF的相关性。结果肺炎合并心力衰竭组血浆NTproBNP和H-FABP水平均高于单纯肺炎组和对照组,LVEF低于单纯肺炎组和对照组(P<0.05)。血浆NT-proBNP和H-FABP水平随心力衰竭分级增高而升高,LVEF随心力衰竭分级增高而降低(P<0.05)。联合检测H-FABP和NTproBNP对小儿重症肺炎合并心力衰竭的诊断效果优于单一检测(P<0.05)。小儿重症肺炎合并心力衰竭患儿NTproBNP和H-FABP与LVEF均呈负相关(r=-0.697和-0.317,P均<0.05)。结论联合检测NT-proBNP和HFABP可早期、准确诊断小儿重症肺炎合并心力衰竭。

Objective To investigate value of combined detection of N terminal brain natriuretic peptide （NT- proBNP） and heart muscle fatty acid-binding protein （H-FABP） in the diagnosis of infants with severe pneumonia associ- ated by heart failure. Methods A total of 396 infants with severe pneumonia admitted during August 2014 and 2015 were divided into simple pneumonia group （n = 356） and pneumonia associated by heart failure group （n = 40） according to whether or not having heart failure, and other healthy 200 infants were selected as control group. Levels of plasma NT- proBNP, H-FABP and left ventricular ejection fraction （LVEF） were detected in 3 groups. The pneumonia associated by heart failure group was divided into mild, moderate and severe subgroups according to cardiac function and changes of plasma NT-proBNP, H-FABP and LVEF levels were observed in the 3 subgroups. Diagnostic effects of NT-proBNP or H- FABP detections alone and combined detection on infants with severe pneumonia associated by heart failure were observed in different subgroups, and correlations between plasma NT-proBNP and H-FABP levels with LVEF level were analyzed. Results In pneumonia associated by heart failure group, plasma NT-proBNP and H-FABP levels were significantly high- er, while LVEF levels were significantly lower than those in simple pneumonia and control groups （P 〈 0. 05 ）. NT-proB- NP and H-FABP levels were increased with the increasing cardiac function classification, while LVEF level was decreased with the increasing cardiac function classification （P 〈 O. 05）. Effect by combined detection of H-FABP and NT-proBNP in diagnosis of infants with severe pneumonia associated by heart failure was superior to those by NT-proBNP or H-FABP detections alone （P 〈 O. 05）. NT-proBNP and H-FABP levels were negatively correlated with LVEF level in infants with severe pneumonia associated by heart failure （r= -0.697 and -0.317, P 〈0. 05）. Conclusion Combined detection of NT-proBNP and H-FABP can early and accurately diagnose infants with severe pneumonia associated by heart failure.