脑钠肽及氮端脑钠肽在窒息新生儿心肌损伤中的应用

Clinical value of serum brain natriuretic peptide levels and N - terminal pronatriuretic peptide lev- els in myocardial injury in neonates after asphyxia

目的探讨血浆脑钠肽（BNP）及氮端脑钠肽（NT-proBNP）水平对窒息新生儿心肌损伤的临床应用价值。方法按患儿就诊顺序编号每间隔一例选取收治的106例窒息患儿为观察组，按照是否有心肌损伤分为心肌损伤组46例和非心肌损伤组60例，同时选取同期收治的无窒息史及心血管系统疾病的63例新生儿为对照组，除外水电解质紊乱和肝肾功能障碍，两组患儿均要求入院日龄〈3 d。对所有入选患儿在入院2 h内及入院2周测定血浆BNP、NT-proBNP、肌酸激酶同工酶（CK-MB）水平。 结果入院2 h内心肌损伤组血浆BNP和NT-proBNP水平明显高于非心肌损伤组及对照组（经Log转换后，t＝7.928，P＝0.030；t＝72.530，P＝0.001），非心肌损伤组高于对照组（t＝43.314，P＝0.020）。心肌损伤患儿经过治疗，2周时血浆BNP和NT-proBNP水平较入院2 h内明显下降，差异有统计学意义（t＝26.523，P＝0.001）。心肌损伤患儿BNP的Cut-off值为108.15 pg/ml时，受试者工作特征（ROC）曲线下面积为0.754，敏感度75.2%，特异度64.6%，阳性预测值56.5%，阴性预测值72.4%；心肌损伤患儿NT-proBNP的Cut-off值为3 615.5 pg/ml时，ROC曲线下面积为0.810，P＝0.001，敏感度为83.4%，特异度为80.6%，阳性预测值82.9%，阴性预测值79.5%。窒息患儿血浆BNP与CK-MB呈正相关（r＝0.212，P＝0.030）。NT-proBNP与CK-MB呈显著正相关（r＝0.406，P＝0.007）。 结论血浆BNP及NT-proBNP水平均能反映窒息患儿心肌损伤情况，可用于窒息新生儿心肌损伤的早期诊断，NT-proBNP有更高的特异性和敏感性。

ObjectiveTo investigate the clinical value of serum brain natriuretic peptide （BNP） levels and N-terminal pronatriuretic peptide （NT-proBNP） levels in myocardial injury in neonates after asphyxia. MethodsSubjects were selected from 106 neonatal asphyxia patients admitted to Department of Neonatology, according to the number organized in chronological order every other case. According to the diagnostic criteria of myocardial injury, these cases were divided into myocardial injury group （n=46） and non-cardiac injury group （n=60）. The control group of 63 neonates was admitted in the same period without asphyxia or neonatal cardiovascular disease. Neonates with water and electrolyte balance disorders and kidney dysfunction were excluded from the controls. Blood sample was drawn from patients within 2 h of admission to hospital and again on day 14. The serum was prepared for the detection of serum BNP, creatine kinase isoenzyme （CK-MB）, serum sodium and calcium. ResultsWithin 2 h after admission, the serum BNP level in the myocardial injury group was significantly higher than in the non-cardiac injury group （log transformed, respectively, P=0.030, P=0.001） and the control group （P=0.020）. After treatment, serum BNP and NT-proBNP levels at 14th day after admission were decreased significantly compared to 2 h within admission （P=0.001）. When the Cut-off value of BNP for children with myocardial injury was 108.05 pg/ml, the area under the receiver operating characteristic （ROC） curve was 0.754, with a sensitivity of 75.2%, a specificity of 64.6%, positive predictive value of 56.5% and negative predictive value of 72.4%. When the Cut-off value of NT-proBNP for children with myocardial injury was 3 615.5 pg/ml, the area under the ROC curve was 0.810, P=0.001, with a sensitivity of 83.4%, a specificity of 80.6%, positive predictive value of 82.9% and negative predictive value of 79.5%. Serum BNP and CK-MB levels were positively correlated in asphyxia patients （r=0.212, P=0.030）. Serum NT-proBNP and CK-MB levels were positively correlated in asphyxia patients （r=0.406, P=0.007）. Conclusion Serum BNP and NT-proBNP levels can reflect myocardial injury in neonates with asphyxia and can be used for early diagnosis of myocardial injury, but NT-proBNP level has a higher specificity and sensitivity.