血清D-二聚体、NT-proBNP联合检测在小儿肺炎支原体感染心肌损害诊断中价值分析

The Value of Combine Detection of Serum D-dimer and NT-proBNP in the Diagnosis of Myocardial Damage Caused by Mycoplasma Pneumoniae Infection in Children

目的探讨血清D-二聚体(D-dimer)、N-末端脑钠素原(NT-proBNP)联合检测对小儿肺炎支原体感染并心肌损害的临床诊断价值。方法选取2018年1月至2020年1月我院收治的肺炎支原体感染并心肌损害患儿108例为研究对象,按照纽约心脏病协会制定心脏功能分级(NYHA)分为I级(28例)、II级(26例)、III级(27例)、IV级(27例)。检测并比较患儿血清D-dimer、NT-proBNP及肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)的差异。结果IV级、III级患儿血清D-二聚体、NT-proBNP及CK-MB、cTnI水平均显著高于I、II级(P<0.05);II级患儿血清D-二聚体、NT-proBNP及CK-MB、cTnI水平显著高于I级(P<0.05)。Pearson相关性分析显示,血清D-二聚体水平与CK-MB、cTnI水平均呈显著正相关(r分别为0.524、0.602,P<0.05);血清NT-proBNP与CK-MB、cTnI水平均呈显著正相关(r分别为0.573、0.621,P<0.05);血清D-二聚体水平与NT-proBNP水平呈显著正相关(r=0.619,P<0.05)。ROC曲线显示,D-二聚体、NT-proBNP、CK-MB、cTnI及D-二聚体+NT-proBNP联合检测对肺炎支原体肺炎并心肌损害诊断的AUC分别为0.728、0.905、0.847、0.743、0.923;灵敏度分别为66.73%、89.47%、71.36%、67.24%、95.03%;特异性分别为73.49%、92.44%、66.28%、72.14%、96.53%。D-二聚体+NT-proBNP联合检测显著高于单一D-二聚体、NT-proBNP的诊断效能(P<0.05)。结论血清D-二聚体、NT-proBNP联合检测有助于肺炎支原体感染并心肌损害患儿的临床诊断及病情判断,对患儿的临床诊疗具有重要应用价值。

Objective To explore the clinical diagnostic value of serum D-dimer and N-terminal pro-brain natriuretic peptide(NT-proBNP)in children with mycoplasma pneumoniae infection and myocardial damage.Methods 108 children with mycoplasma pneumoniae infection and myocardial damage in our hospital from January,2018 to January,2020 were selected as the research objects,who were divided into groups of grade I(28 cases),grade II(26 cases),grade III(27 cases)and grade IV(27 cases)according to the NYHA established by New York Heart Association.Serum D-dimer,NT-proBNP and creatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnI)levels were detected and compared among groups.Results Serum D-dimer,NT-proBNP,CK-MB,and cTnI levels in children with grade IV and grade III were significantly higher than those of grade I,and II(P<0.05).Serum D-dimer in children with grade II,as well as the levels of NT-proBNP,CK-MB and cTnI were significantly higher than those of grade I(P<0.05).Pearson correlation analysis showed that serum D-dimer level was significantly positively correlated with CK-MB and cTnI levels(r were 0.524 and 0.602,respectively,P<0.05).Serum NT-proBNP was positively correlated with CK-MB and cTnI levels(r was 0.573,0.621,P<0.05).The serum D-dimer level was significantly positively correlated with the level of NT-proBNP(r=0.619,P<0.05).The ROC curve showed that the AUCs of D-dimer,NT-proBNP,CK-MB,cTnI and D-dimer+NT-proBNP combined detection for mycoplasma pneumoniae pneumonia and myocardial damage were 0.728,0.905,0.847,0.743,and 0.923,respectively.Sensitivities were 66.73%,89.47%,71.36%,67.24%,and 95.03%,and specificities were 73.49%,92.44%,66.28%,72.14%,and 96.53%,respectively.The performance of combined detection of D-dimer+NT-proBNP was significantly higher than that of single D-dimer or NT-proBNP(P<0.05).Conclusion The combined detection of serum D-dimer and NT-proBNP is helpful to the clinical diagnosis and condition judgment of children with mycoplasma pneumoniae infection and myocardial damage,and has an important application value in clinical diagnosis and treatment of children.