新生儿呼吸窘迫综合征血清N末端脑钠肽前体水平与病情评估及预后的相关性研究

Study on correlation between serum N-terminal pro-brain natriuretic peptide levels and condition assessment and prognosis of neonates with acute respiratory distress syndrome

目的:探讨N末端脑钠肽(NT-proBNP)在新生儿呼吸窘迫综合征(ARDS)中的病情评估及死亡预后的预测价值。方法:选取2014-01—2017-12期间在我院新生儿科住院的72例新生儿ARDS患儿为研究对象,记录其入院后新生儿危重病例评分(NCIS)并检测血清NT-proBNP,并对患儿的NCIS、血清NT-proBNP进行相关性分析,建立线性回归方程;依据患儿的NCIS评分,将患儿分为非危重组、危重组和极危重组,比较不同组别的NT-proBNP及病死率;采用受试者工作特征(ROC)曲线评价血清NT-proBNP水平对患儿住院期间发生死亡的预测作用。结果:极危重组血清NT-proBNP高于危重组,危重组高于非危重组,差异有统计学意义(P<0.01);线性相关分析结果显示,NCIS评分越低,NT-proBNP水平越高,二者呈明显负相关关系(r=-0.945,P<0.01);患儿NT-proBN水平越高预后越差:极度危重组病死率明显高于危重组,危重组高于非危重组(!2=16.532,P<0.01);ROC曲线评价表明,血清NT-proBNP水平对新生儿ARDS预后判断价值有统计学意义(P<0.01,AUC=0.0.882,95%CI0.787~0.977)。结论:检测血清NT-proBNP可以快速判断新生儿ARDS病情,并且NT-proBNP可作为新生儿ARDS转归的早期预测指标。

Objective：To investigate the evaluation and predictive value of death prognosis of N-terminal brain natriuretic peptide（NT-proBNP）in neonates with acute respiratory distress syndrome（ARDS）.Method：Seventytwo neonates with ARDS in the department of neonatal of The third people＇s hospital of yancheng from January2014 to December 2017 were selected as the study subjects and recorded the scores of neonatal critically ill cases（NCIS）after admission and measured serum NT-proBNP.A linear regression equation was established for the correlation analysis of NCIS and serum NT-proBNP level in neonates.According to the NCIS scores,the neonates were divided into non-critical group,critical group,and extremely critical group.The NT-proBNP levels and fatality rates of different groups were compared.The predictive efficiency of serum NT-proBNP levels wasevaluated by using the subject＇s working characteristic curve（ROC）.Result：We founded that the NT-proBNP level of extremely critical group was higher than that of the critical group,and the critical group was higher than the non-critical group.The difference was statistically significant（P〈0.01）.The result showed that the lower the NCIS score and the higher the serum NT-proBNP level,the negative correlation was obvious（r=-0.945,P〈0.01）.The higher the serum NT-proBNP level,the worse it was.The mortality of the extremely critical group was higher than that of the critical group,and the critical group was higher than the non-critical group（!2=16.532,P〈0.01）.Analysis of ROC curve showed that the sensitivity and specificity of serum NT-proBNP level showed a statistically significant predictive value in prognosis of sepsis（P〈0.01,AUC=0.0.882,95%CI 0.0.787-0.977）.Conclusion：Serum NT-proBNP level could quickly determine the severity of neonatal ARDS,and The serum level NT-proBNP may be used as a critical parameter in predicting the prognosis of neonatal ARDS.