N末端脑钠肽前体在新生儿高胆红素血症患儿中的表达及临床意义

Expression and clinical significance of the level of serum N-terminal pro-brain natriuretic peptide(NT-proBNP ) in neonates with hyperbilirubinemia

目的探讨N末端脑钠肽前体(NT-proBNP)在新生儿高胆红素血症患儿中的表达水平,评估其临床应用价值。方法选取2016-01-01—2017-01-01某医院新生儿病房收治的120例新生儿高间接胆红素血症患儿为观察组,依据血清总胆红素(TBiL)水平分为轻中度黄疸组(TBiL<342mol/L)60例,重度黄疸组(TBiL≥342mol/L)60例,按照随机数表法选取同期因其他疾病住院的无新生儿高胆红素血症的患儿60例为对照组。比较各组患儿入院时TBiL、NT-proBNP、肌钙蛋白(cTnI)及胱抑素C(CystatinC)指标,采用Pearson相关性分析NT-proBNP、cTnI、CystatinC与TBiL的关系。予观察组患儿光疗等综合治疗,检测观察组患儿治疗前后TBiL、NT-proBNP指标,比较治疗前后各指标变化情况,予观察组急性期完善心电图及头MR检查,并观察有无心肌损害临床表现。比较各组预后不良事件的发生率。结果三组新生儿NT-proBNP、cTnI、CystatinC比较差异均有统计学意义(F值分别为37.42,163.64,5.59,P均<0.05)。重度黄疸组患儿NT-proBNP水平明显高于轻中度黄疸组及对照组,两两比较,差异均有统计学意义(P<0.05)。重度黄疸组患儿cTnI、CystatinC水平明显高于轻中度黄疸组及对照组,差异有统计学意义(P<0.05)。轻中度黄疸组及重度黄疸组患儿治疗后TBiL及NT-proBNP水平均低于治疗前,差异有统计学意义(P<0.05)。经Pearson相关性分析显示,观察组NT-proBNP、cTnI、CystatinC与TBiL均呈正相关关系(r=0.613,0.495,0.423,P均<0.05)。另外NT-proBNP与cTnI也呈正相关(r=0.616,p=0.000)。轻中度黄疸组预后不良事件的发生率是5%,重度黄疸组预后不良事件的发生率是31%,经χ^2检验,差异有统计学意义(χ^2=4.545,P=0.033<0.05)。结论NT-proBNP在新生儿高胆红素血症患儿中呈高表达,NT-proBNP水平能反映新生儿高胆红素患儿黄疸严重程度,黄疸越重,NT-proBNP水平越高。可以早期检测NT-proBNP水平,间接评估高胆红素血症患儿心脏及肾脏损伤程度,NT-proBNP可作为判断新生儿高胆红素血症患儿预后的参考指标。

Objective To explore the expression levels of serum N-terminal pro-brain natriuretic peptide(NT-proBNP) in neonates with hyperbilirubinemia and estimate its clinical significance.Methods 120 neonates with hyperbilirubinemia treated in a hospital from January 1,2016 to January 1,2017,were selected as the observation group.They were further divided into the mild-moderate group (60 neonates,TBiL<342 mol/L) and the severe group(60 neonates,TBiL≥342 mol/L) according to the levels of TBiL.At the same time 60 neonates without hyperbilirubinemia were selected as the control group.The levels of serum TBiL,NT-proBNP,cTnI,Cystatin C in the three groups at the time of hospital admission were compared.Pearson correlation analysis was used to analyze the relationships between serum NT-proBNP,cTnI,Cystatin C and TBiL.The neonates in the observation group were treated with phototherapy and other basic therapies.Indexes of TBiL,NT-proBNP of the neonates in the observation group were tested and their changes were compared before and after the treatment.ECG and head MRI were given to the neonates at the acute phase and their clinical manifestation of myocardial damage was recorded.The incidence of adverse prognosis events between groups was compared.Results There were statistically significant difference in the levels of serum NT-proBNP,cTnI,Cystatin C among the three groups(F=37.42,163.64,5.59,P<0.05).The levels of serum NT-proBNP,cTnI,Cystatin C in the severe group were statistically significantly higher than those in the mild-moderate group and the control group (P<0.05).The levels of TBiL and NT-proBNP of the mild-moderate group and the severe group were lower than those before the treatment and the difference was of statistical significance(P<0.05).Pearson correlation analysis showed that serum NT-proBNP,cTnI,Cystatin C were positively correlated with TBiL in the observation group (r=0.613,0.495,0.423,P<0.05).And there was positive correlation between serum NT-proBNP and cTnI(r=0.616,P=0.000).The incidence rate of adverse prognosis events in the severe group was 31%,statistically significantly higher than that in the mild-moderate group(5%)(χ^2=4.545,P=0.033<0.05).Conclusion The level of serum NT-proBNP was markedly high in neonates with hyperbili- rubinemia.The level of NT-proBNP could reflect the severity of hyperbilirubinemia,the severer the aurigo,the higher levels of NT-proBNP.The level of serum NT-proBNP could be detected at early phase to indirectly evaluate heart and kidney injuries among neonates with hyperbilirubinemia.The serum level NT-proBNP may be used as a critical parameter in predicting the prognosis of neonates with hyperbilirubinemia.