地塞米松防治支气管肺发育不良对N端脑钠肽前体水平的影响及临床意义

Effect and clinical significance of bronchopulmonary dysplasia treated by dexamethasone on N-terminal pro-brain natriuretic peptide level

目的探讨地塞米松防治早产儿支气管肺发育不良（bronchopulmonary dysplasia，BPD）对血浆N端脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）水平的影响，以及血浆NT-proBNP水平与发生BPD及严重程度的关系。方法前瞻性选择2014年12月至2016年10月本院新生儿重症监护病房收治的胎龄〈32周、出生体重〈1 500 g需呼吸机支持的重度（Ⅲ～Ⅳ级）新生儿呼吸窘迫综合征（respiratory distress syndrome，RDS）患儿。根据生后14 d是否需继续呼吸机支持分为撤机组和非撤机组，再将非撤机组分为地塞米松治疗组和未治疗组。采用固相免疫层析法检测各组患儿生后14 d和28 d血浆NT-proBNP水平，分析应用地塞米松治疗对血浆NT-proBNP水平的影响，以及血浆NT-proBNP水平与发生BPD的相关性。结果共纳入重度RDS早产儿157例，其中撤机组108例，非撤机组49例。（1）撤机组患儿出生体重大于非撤机组，生后14 d血浆NT-proBNP水平低于非撤机组，差异有统计学意义（P〈0.05）。（2）生后14 d非撤机组患儿应用地塞米松治疗30例，未治疗19例；治疗组生后28 d血浆NT-proBNP水平低于未治疗组[（2.42±0.47） pg/ml比（2.90±0.44） pg/ml]，差异有统计学意义（P〈0.05）；两组患儿生后28 d血浆NT-proBNP水平均低于生后14 d，差异有统计学意义（P〈0.05）。（3）地塞米松治疗组中重度BPD发生比例明显低于未治疗组（3/30比8/19），且生后28 d血浆NT-proBNP水平低于未治疗组[（2.72±0.51） pg/ml比（3.09±0.30） pg/ml]，差异有统计学意义（P〈0.05）。两组发生BPD患儿生后28 d血浆NT-proBNP水平均高于未发生BPD患儿，差异有统计学意义（P〈0.05）。结论地塞米松可降低重度RDS患儿血浆NT-proBNP水平并减少BPD的发生，血浆NT-proBNP水平与发生BPD及严重程度密切相关，动态监测对临床有一定指导意义。

ObjectiveTo evaluate the level of plasma N-terminal pro-brain natriuretic peptide （NT-proBNP） in preterm infants with bronchopulmonary dysplasia （BPD） after dexamethasone administration and its correlation with the occurrence and severity of BPD.MethodThe preterm infants in NICU from December 2014 to October 2016 were enrolled in this prospective study. All of the infants were less than 32 weeks′gestational age （GA） and less than 1 500 g birth weight （BW） and they all underwent mechanical ventilation for severe （stage Ⅲ-Ⅳ） respiratory distress syndrome （RDS）. The infants were assigned to weaning group and non-weaning group according to whether they underwent mechanical ventilation after 14 days of birth. Then the non-weaning group were assigned into the therapy group and control group according to whether treated by dexamethasone. By 14 and 28 days after birth, immunochromatography assay was used to detect the serum NT-proBNP respectively and the results were compared among the groups.ResultA total of 157 preterm infants with severe RDS were included, 108 in the weaning group, the remaining 49 in the non-weaning group. （1）Compared with the non-weaning group, the weaning group had higher birth weight and lower plasma NT-proBNP level on day 14 （P〈0.05）. （2）On day 28, all of the 30 infants in the dexamethasone treated group showed significantly lower plasma NT-proBNP level than the 19 infants in the control group [（2.42±0.47） pg/ml vs.（2.90±0.44） pg/ml]（P〈0.05）. （3）Both of the occurrence of moderate to severe BPD and the plasma NT-pro BNP level on day 28 in the dexamethasone treated group were lower than that in the non-treated group （3/30 vs.8/19） and [（2.72±0.51） pg/ml vs.（3.09±0.30） pg/ml]（P〈0.05）. The plasma NT-proBNP level in the infants with BPD was higher than that in the infants without it and the difference was statistically significant（P〈0.05）.ConclusionDexamethasone could reduce the incidence of BPD and the level of plasma NT-proBNP in infants with severe RDS. The plasma NT-pro BNP level was associated with the occurrence and severity of BPD, thus dynamic monitoring its change could be beneficial.