脑钠肽联合超声心动图对早产儿肺动脉高压疗效评价及预测预后价值分析

Brain natriuretic peptide combined with echocardiography and pulmonary arterial hypertension in premature infants:a review on curative effect and an analysis on predictive value

目的探究脑钠肽(BNP)联合超声心动图对早产儿肺动脉高压的疗效评价及预后的预测价值。方法选取2015年3月~2018年3月于东南大学医学院附属南京同仁医院出生并治疗的早产肺动脉高压患儿48例为观察组,选取同期出生的早产儿但未患肺动脉高压的新生儿48例为对照组。比较观察组病情轻、中、重患儿的肺动脉收缩压(PASP)、右心室前后径及主动脉前后径,比较观察组治疗前后和对照组同期BNP、PASP测量值;分析BNP和肺动脉压力值的相关性;随访并统计患儿1年内心血管相关再入院事件,评价BNP联合超声心动图对心血管再入院的预测价值。结果治疗前观察组BNP和PASP、右心室前后径、主动脉内径测量值均高于对照组,差异有统计学意义(P<0.01);观察组治疗后BNP大于对照组(P<0.05)。不同程度肺动脉高压患儿治疗前后BNP、PASP、右心室前后径和主动脉内径均随着疾病严重程度增加而升高,治疗后各项指标均低于治疗前,差异均有统计学意义(P<0.05)。BNP与PASP、右心室前后径和主动脉内径成正相关(r=0.426、0.512、0.537,P<0.05)。BNP和超声心动图联合预测患儿1年内因心血管不良事件再入院的准确率、灵敏度、特异度、阳性预测值和阴性预测值均高于单独诊断(P<0.05)。结论BNP在肺动脉高压早产儿表达升高,BNP联合超声心动图对早产儿肺动脉高压具有一定诊断价值,同时可准确预测预后,为临床治疗方案的制定提供帮助。

Objective To investigate the review on curative effect and predictive value to prognosis of brain natriuretic peptide(BNP)combined with echocardiography in premature infants with pulmonary arterial hypertension(PAH).Methods The premature infant patients were chosen into observation group and premature infants without PAH were chosen into control group at the same time(each n=48)from Nanjing Tongren Hospital affiliated to Southeast University Medical College from Mar.2015 to Mar.2018.The pulmonary artery systolic pressure(PASP),right ventricular anteroposterior diameter(RVAPD)and aortic diameter(AoD)were compared in premature infant patients with mild,medium and severe PAH in observation group.The detected values of BNP and PASP were compared between observation group and control group before and after treatment.The correlation between BNP and pulmonary artery pressure was analyzed.The premature infant patients were followed up for 1 y and cardiovascular-related rehospitalization events were counted.The predictive value of BNP combined with echocardiography to cardiovascularrelated re-hospitalization events.Results Before treatment,BNP,PASP,RVAPD and AoD all were higher in observation group than those in control group(P<0.01).BNP was higher in observation group than that in control group(P<0.05)after treatment.BNP,PASP,RVAPD and AoD increased as the increase of PAH severity in premature infant patients with different PAH degrees before and after treatment,and all indexes were lower after treatment(P<0.05).BNP was positively correlated to PASP(r=0.426),RVAPD(r=0.512)and AoD(r=0.537,P<0.05).BNP combined with echocardiography had higher accuracy,sensitivity,specificity,positive predictive value and negative predictive value in predicting adverse cardiovascular events-related re-hospitalization rate than single BNP or single echocardiography.Conclusion BNP increases in premature infants with PAH.BNP combined with echocardiography has some diagnostic value to PAH and predict prognosis in premature infant patients.