BNP及NT-proBN诊断早产儿动脉导管未闭临床分析

Clinical Analysis of BNP and NT-proBN in the Diagnosis of Patent Ductus Arteriosus in Premature Infants

目的探讨B型尿钠肽(BNP)及氨基末端B型尿钠肽前体(NT-proBN)在诊断早产儿动脉导管未闭(PDA)中的临床价值。方法收集2016年3月~2018年8月赣州市人民医院NICU收治的患PDA早产儿200例设为试验组,其中有血流动力学意义的PDA患儿100例设为hsPDA组,给予布洛芬混悬液口服治疗;无血流动力学意义的PDA患儿100例设为nhsPDA组;选取同期入院无心脏疾病100例设为nPDA组;分别于出生第2~7天监测两组患儿BNP和NT-proBN并比较。结果入院第2天hsPDA组血浆BNP、NT-proBN与nPDA组比较均较高,差异均有统计学意义(P<0.05);nhsPDA组血浆BNP、NT-proBN与nPDA组比较,差异均有统计学意义(P<0.05);出生第2~7天,血浆BNP水平预测早产儿hsPDA的受试者工作特征(ROC)曲线下面积为0.860(95%CI:0.902~0.768)。最佳界值为306.53ng/L,敏感度为78.63%,特异度为79.42%;血浆NT-proBN预测早产儿hsPDA的ROC曲线下面积为0.921(95%CI:2.323~0.826),最佳界值为8964.26ng/L,敏感度为92.32%,特异度为96.42%;且药物治疗早产儿hsPDA有效的患儿血浆NT-proBNP水平下降幅度大于治疗无效的患儿,治疗前后比较,差异有统计学意义(P<0.05)。结论早期早产儿出生第2~7天血浆BNP水平有助于预测早产儿发生hsPDA,且联合检测NT-proBNP,既能提高诊断早产儿hsPDA的准确性,而且还可利用NT-proBNP水平下降幅度评估药物治疗hsPDA的有效性。

Objective To investigate the clinical value of B-type natriuretic peptide (BNP) and amino-terminal B-type natriuretic peptide precursor (NT-proBN) in the diagnosis of patent ductus arteriosus (PDA) in premature infants. Methods 200 patients with PDA premature infants admitted to the NICU of Ganzhou People's Hospital from March 2016 to August 2018 were enrolled as the experimental group. Among them, 100 patients with hemodynamically significant PDA were enrolled in the hsPDA group and given ibuprofen. The suspension was treated orally;100 patients with PDA without hemodynamics were enrolled in the nhsPDA group;100 patients with no heart disease were enrolled in the nPDA group at the same time;BNP and NT-proBN were compared between the two groups on the 2nd to 7th day of birth.Results On the second day of admission, plasma BNP, NT-proBN and nPDA groups were higher in the hsPDA group, the difference was statistically significant (P<0.05). The plasma BNP, NT-proBN and nPDA groups in the nhsPDA group were statistically different (P<0.05);On days 2-7, the plasma BNP level predicted the area under the receiver operating characteristic (ROC) curve of premature infants with hsPDA of 0.860 (95% CI: 0.902 to 0.768). The best cut-off value was 306.53 ng/L, the sensitivity was 78.63%, and the specificity was 79.42%. Plasma NT-proBN predicted the area under ROC curve of premature infant hsPDA was 0.921 (95% CI: 2.323~0.826), the best cut-off value was 8962.26 ng/L, the sensitivity was 92.32%, and the specificity was 96.42%;and the plasma NT-proBNP level in children with effective hsPDA was higher than that in children with treatment failure. Before and after treatment, the difference was statistically significant (P<0.05).Conclusion Plasma BNP levels on the 2nd to 7th day of early preterm birth are helpful in predicting hsPDA in preterm infants, and combined detection of NT-proBNP can improve the accuracy of diagnosis of hsPDA in preterm infants, and can also be used to assess the decline in NT-proBNP levels. The effectiveness of drug therapy for hsPDA.