多层螺旋CT联合血清CK-MB及NT-pro BNP在诊断儿童复杂性先天性心脏病中的应用价值

The value of multi-slice spiral CT combined with serum CK-MB and NT-pro BNP in diagnosis of complex congenital heart disease in children

目的:探究多层螺旋CT(MSCT)联合血清N末端脑钠肽前体(NT-pro BNP)及肌酸激酶同工酶(CK-MB)在诊断儿童复杂性先天性心脏病(CCHD)中的应用价值。方法:按照最终手术结果,将接受MSCT检查并进行手术治疗的126例疑似CCHD患儿分为CCHD组(n=89)和非CCHD组(n=37)。对比两组患者的血清CK-MB、NT-pro BNP水平,就血清CK-MB、NT-pro BNP与CCHD患儿病情严重程度的相关性进行分析,同时对MSCT、MSCT联合血清CK-MB和NT-pro BNP在诊断CCHD上的诊断效能进行比较。结果:126例疑似CCHD患儿最终经手术确诊89例,89例CCHD患儿经手术证实412处畸形,其中心内结构畸形256处,心脏与大血管连接处畸形95处,心外大血管畸形61处。CCHD组患儿的血清CK-MB、NT-pro BNP水平高于非CCHD组,差异有统计学意义(P<0.05)。Pearson分析发现,血清CK-MB、NT-pro BNP水平与CCHD患儿病情严重程度呈正相关(r=0.216、P=0.005;r=0.236、P=0.003)。MSCT联合血清CK-MB、NT-pro BNP在诊断CCHD上的AUC、敏感度、特异度和准确度分别为0.918、94.38%、100.00%、96.03%,略高于单一MSCT诊断比较,但差异均无统计学意义(P>0.05)。结论:MSCT在诊断CCHD上的诊断准确率较高,CCHD患儿的血清CK-MB、NT-pro BNP与其病情严重程度密切相关,MSCT联合血清CK-MB、NT-pro BNP监测可进一步为CCHD患儿临床手术方案的制定及预后评估提供重要依据。

Objective:To discuss the value of multi-slice spiral CT(MSCT)combined with serum N-terminal brain natriuretic peptide precursor(NT-pro BNP)and creatine kinase isoenzyme(CK-MB)in the diagnosis of complex congenital heart disease(CCHD)in children.Methods:126 CCHD children who underwent multi-slice spiral CT examination and surgical treatment were divided into CCHD group(n=89)and non-CCHD group(n=37)according to the final surgical results.Serum CK-MB,NT-pro BNP levels were compared between the two groups,and the correlation between serum CK-MB,NT-pro BNP and the severity of CHD was scored.Meanwhile,the diagnostic efficacy of MSCT,MSCT combined with serum CK-MB and NT-pro BNP in the diagnosis of CCHD were compared.Results:89 cases of CCHD were finally diagnosed by surgery in 126 children suspected of CCHD.There were 412 malformations in 89 children with CCHD,including 256 intracardiac malformations,95 cardiac malformations and 61 extracardiac malformations.The levels of serum CK-MB and NT Pro BNP in CCHD group were significantly higher than those in non CCHD group(P<0.05).Pearson analysis showed that serum CK-MB and NT-pro BNP levels were positively correlated with the severity of CCHD(r=0.216,P=0.005 vs.r=0.236,P=0.003).The AUC,sensitivity,specificity and accuracy of MSCT combined with serum CK-MB and NT-pro BNP in the diagnosis of CCHD were 0.918,94.38%,100.00%and 96.03%respectively,which were slightly higher than those of single MSCT,with no significant difference(P>0.05).Conclusion:MSCT has very high diagnostic accuracy in the diagnosis of CCHD.Serum CK-MB and NT-pro BNP are closely related to the severity of CCHD.MSCT combined with serum CK-MB and NT-pro BNP can provide the important basis for the formulation of clinical surgical procedures and prognosis evaluation.