血浆脑钠肽水平在左向右分流型先天性心脏病患儿心功能评级中的应用价值

Application value of plasma brain natriuretic peptide level in cardiac function rating of children with left-to-right shunt congenital heart disease

目的探讨血浆脑钠肽(BNP)水平在左向右分流型先天性心脏病患儿心功能评级中的应用价值。方法选取中山市博爱医院、大涌医院2017年4月至2019年8月收治的左向右分流型先天性心脏病患儿60例(右心型和左心型各30例)为研究对象,其中右心型先天性心脏病患儿为研究1组,左心型先天性心脏病患儿为研究2组,另选取同时间段常规体检的健康儿童30例为对照组。三组均进行血浆BNP浓度测定和超声心动图测量,比较三组血浆BNP浓度水平、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、右室舒张末期内径(RVEDD)、肺循环血流量/体循环血流量比值(Qp/Qs)及左室心肌做功(Tei)指数。结果研究1组LVEF、RVEDD与对照组比较,差异均无统计学意义(均P>0.05);研究1组的LVEDD[(45.40±7.48)mm]、Qp/Qs[(1.80±0.25)]、左室Tei指数[(0.35±0.14)]、BNP[(64.33±22.18)ng/L]均明显高于对照组[(34.33±4.93)mm、(0.95±0.11)、(0.28±0.05)、(33.66±10.80)ng/L],差异均有统计学意义(t=6.77、17.05、2.56、6.81,均P<0.05);研究2组的LVEF、RVEDD与对照组比较,差异均无统计学意义(均P>0.05);研究2组的LVEDD[(45.39±7.52)mm]、Qp/Qs[(1.78±0.25)]、左室Tei指数[(0.35±0.14)]、BNP[(64.30±22.21)ng/L]均明显高于对照组[(34.33±4.93)mm、(0.95±0.11)、(0.28±0.05)、(33.66±10.80)ng/L],差异有统计学意义(t=6.74、16.64、2.58、6.80,均P<0.05);研究1组的BNP水平与RVEDD、Qp/Qs、左室Tei指数均呈正相关(r=0.629、0.719、0.651,均P<0.05);研究2组的BNP水平与RVEDD、Qp/Qs、左室Tei指数均呈正相关(r=0.539、0.792、0.748,均P<0.05);研究1组与研究2组的BNP水平、LVEF均无相关性(均P>0.05)。研究1组手术后BNP[(44.05±12.41)ng/L]、LVEDD[(43.48±4.45)mm]、Qp/Qs[(1.03±0.06)]、左室Tei指数[(0.31±0.10)]均低于该组手术前,差异均有统计学意义(t=5.23、2.94、18.20、3.34,均P<0.05);研究2组手术后BNP[(40.96±14.30)ng/L]、LVEDD[(22.23±3.65)mm]、Qp/Qs[(1.05±0.11)]、左室Tei指数[(0.31±0.05)]均低于该组手术前,差异均有统计学意义(t=3.86、3.08、14.73、4.26,均P<0.05)。结论在左向右分流型先天性心脏病患儿心功能评级中应用血浆BNP水平检测的效果确切,有一定的应用价值。

Objective To explore the application value of plasma brain natriuretic peptide(BNP)level in cardiac function rating of children with left-to-right shunt congenital heart disease.Methods Sixty children with left-to-right shunt congenital heart disease(30 cases of right heart type and 30 cases of left heart type)admitted to Zhongshan Boai Hospital and Dayong Hospital from April 2017 to August 2019 were selected in this research.Children with right heart type congenital heart disease were selected as study group 1,children with left heart type congenital heart disease were selected as study group 2,and 30 healthy children undergoing routine physical examination at the same time period were selected as control group.Plasma BNP concentration and echocardiogram were measured in all three groups.The plasma BNP level,left ventricular ejection fraction(LVEF),left ventricular end diastolic inner diameter(LVEDD),right ventricular end diastolic inner diameter(RVEDD),pulmonary circulation blood flow/systemic circulation blood flow ratio(Qp/Qs)and left ventricular Tei index were observed and compared among the three groups.Results The LVEF and RVEDD in the study group 1 were not significantly different from those in the control group(all P>0.05).The LVEDD[(45.40±7.48)mm],Qp/Qs(1.80±0.25),left ventricular Tei index(0.35±0.14),BNP[(64.33±22.18)ng/L]in the study group 1 were significantly higher than those in the control group[(34.33±4.93)mm,(0.95±0.11),(0.28±0.05),(33.66±10.80)ng/L],the differences were statistically significant(t=6.77,17.05,2.56,6.81,all P<0.05).The LVEF and RVEDD in the study group 2 were not significantly different from those in the control group(all P>0.05).The LVEDD[(45.39±7.52)mm],Qp/Qs(1.78±0.25),left ventricular Tei index(0.35±0.14)and BNP[(64.30±22.21)ng/L]in the study group 2 were significantly higher than those in the control group[(34.33±4.93)mm,(0.95±0.11),(0.28±0.05),(33.66±10.80)ng/L],the differences were statistically significant(t=6.74,16.64,2.58,6.80,all P<0.05).The BNP level in study group 1 was positively correlated with RVEDD,Qp/Qs and left ventricular Tei index(r=0.629,0.719,0.651,all P<0.05).The BNP level in the study group 2 was positively correlated with RVEDD,Qp/Qs and left ventricular Tei index(r=0.539,0.792,0.748,all P<0.05).There were no correlations between BNP level and LVEF in the study group 1 and study group 2(all P>0.05).After operation,the BNP[(44.05±12.41)ng/L],LVEDD[(43.48±4.45)mm],Qp/Qs(1.03±0.06)and left ventricular Tei index(0.31±0.10)in the study group 1 were lower than those before operation,and the differences were statistically significant(t=5.23,2.94,18.20,3.34,all P<0.05).After operation,the BNP[(40.96±14.30)ng/L],LVEDD[(22.23±3.65)mm],Qp/Qs(1.05±0.11)and left ventricular Tei index(0.31±0.05)in the study group 2 were lower than those before operation,and the differences were statistically significant(t=3.86,3.08,14.73,4.26,all P<0.05).Conclusion The application of plasma BNP level detection in left-to-right shunt congenital heart disease has definite effect and certain application value.