NT-proBNP、CK-MB、cTNⅠ对先天性心脏病合并肺炎患儿心力衰竭的诊断界值及心脏手术术后结局的预测价值

Diagnosis and Postoperative Predictive Value of NT-proBNP,CK-MB and cTNⅠ in Children with Congenital Heart Disease with Pneumonia

目的探究N端脑钠肽前体(NT-proBNP)、心肌酶对先天性心脏病合并肺炎患儿心力衰竭的诊断界值,以及对先天性心脏病患儿手术预后的预测价值。方法收集2015年1月至2017年1月入住上海儿童医学中心呼吸科、儿科重症监护病房(PICU)的先天性心脏病合并肺炎且肺炎恢复后行心脏手术患儿140例进行数据统计和临床分析,包括年龄,性别,体质量,身高,诊断,心脏重症监护病房(CICU)住院时间,术后机械通气时间,术后死亡,Aristotele分值,NT-proBNP,肌酸激酶(CK),肌酸激酶同工酶(CK-MB),心肌肌钙蛋白Ⅰ(cTNⅠ)等。对心功能正常与心功能不全组NT-proBNP、心肌酶水平进行对比,并计算诊断先天性心脏病合并肺炎患儿心力衰竭的诊断界值及分析NT-proBNP及心肌酶对先天性心脏病术后并发症及手术结局的预测价值。结果心功能不全组患儿血浆NT-proBNP、cTNⅠ、CK-MB水平较心功能正常组患儿高,NT-proBNP用于诊断先天性心脏病肺炎合并心功能不全的界值为2 929.5 ng/m L,灵敏度为62.0%,特异度为65.6%。心脏手术后发生并发症组与无术后并发症组患儿NT-proBNP、CK-MB之间存在差异,与术后发生并发症数目之间存在弱的相关性,与部分术后并发症的发生之间也有相关性。用年龄+体表面积(BSA)+Aristotele评分建立预测模型,Cox回归分析发现加入lg NT-proBNP及cTNⅠ后其预测价值升高。结论 NT-proBNP用于判断先天性心脏病合并肺炎患儿发生心力衰竭的界值为2 929.5 ng/m L。NT-proBNP、CK-MB升高提示发生术后并发症可能大。NT-proBNP、cTNⅠ可用于先天性心脏病手术预后的预测。

Objective To study the diagnostic boundary value of N-terminal pro-brain natriuretic peptide（NTproBNP）,myocardial enzyme of heart failure in children with congenital heart disease and pneumonia,and their predictive value for prognosis of children with congenital heart disease after surgery.Methods A total of 140 patients with congenital heart disease complicated with pneumonia admitted to Department of Respiratory Medicine and Pediatric Intensive Care Unit（PICU）,Shanghai Children＇s Medical Center during Jan.2015 and Jan.2017 were collected,then data statistics and clinical analysis were carried out.The statistical items included the general condition of children,such as age,sex,body mass,body height,diagnosis,stay length in cardiac intensive care unit（CICU）,postoperative mechanical ventilation time,postoperative death,Aristotele score,NT-proBNP,creatine kinase（CK）,creatine kinase isoenzymes（CK-MB） and cardiac troponin I（cTNⅠ）.The NT-proBNP and CK levels in normal cardiac function group and cardiac insufficiency group were compared,and the diagnostic boundary value of heart failure in children with congenital heart disease combined with pneumonia was calculated,and the predictive value of NT-proBNP and CK for postoperative complications and surgical outcome of congenital heart disease was analyzed.Results The plasma NT-proBNP,cTNⅠ and CK-MB levels in children with cardiac dysfunction were higher than those in children with normal heart function.The diagnostic value of NT-proBNP for congenital heart disease combined with pneumonia and heart dysfunction was 2 929.5 ng/m L,with a sensitivity of 62.0% and a specificity of 65.6%.There were differences in NT-proBNP and CK-MB in patients with and without postoperative complications,and there was a weak correlation between the number of postoperative complications and NT-proBNP and CK-MB.The prediction model was established by age ＋ body surface area（BSA） ＋ Aristotele score,and Cox regression analysis found that the predictive value increased after adding lg NT-proBNP and cTNⅠ.Conclusion NT-proBNP can be used to diagnose heart failure in children with congenital heart disease combined with pneumonia,and the cut-off value is 2 929.5 ng/m L.The elevation of NT-proBNP and CK-MB suggests that postoperative complications may happen.NT-proBNP and cTNⅠ can be used to predict the prognosis of pediatric cardiac surgery.