N端脑利钠肽前体在新生儿缺氧缺血性心肌损伤中的变化

Changes of N-terminal pro-brain natriuretic peptide in neonates with myocardial ischemic injury

摘要:

目的：探讨N端脑利钠肽前体(NT-proBNP)在缺氧缺血性脑病(HIE)合并心肌损伤患儿中的变化，为临床早期诊断及治疗提供理论依据。方法：选择我院收住的35例HIE患儿为研究对象(心肌损伤17例，非心肌损伤18例)，以20例正常新生儿为对照组，应用ELASA方法测定血浆NT-proBNP 水平。结果：①心肌损伤患儿NT-proBNP水平(338.8±76.2 fmol/mL) 显著高于非心肌损伤组(137.5±45.1 fmol/mL) 和对照组(113.7±53.6 fmol/mL), 均P<0.01。②轻、中、重度HIE组NT-proBNP水平分别为141.3±41.6、271.8±118.1和347.2±85.1 fmol/mL，中、重度HIE组显著高于对照组（P<0.01）；轻、中、重度HIE组间比较差异有显著性，P<0.05。③心肌损伤组急性期血浆NT-proBNP水平明显高于恢复期(338.8±76.2 fmol/mL vs 225.0±80.0 fmol/mL), P<0.01。结论：心肌损伤患儿急性期NT-proBNP水平升高。对HIE患儿检测血浆NT-proBNP有助于早期诊断心肌损伤，判断HIE病情。［中国当代儿科杂志，2009，11（12）：973-975］

Abstract:

OBJECTIVE: To investigate the changes of N-terminal pro-brain natriuretic peptide (NT-proBNP) in neonates with hypoxic-ischemic encephalopathy (HIE) complicated by myocardial ischemic injury. METHODS: Thirty-five neonates with HIE (17 cases with concurrent myocardial injury and 18 cases without) were enrolled. Twenty healthy neonates were used as the control group. Plasma NT-proBNP levels were measured using enzyme immunoassay. RESULTS: The mean plasma NT-proBNP levels in patients with myocardial injury (338.8±76.2 fmol/mL) were significantly higher than those in patients with non-myocardial injury (137.5±45.1 fmol/mL) and in the control group (113.7±53.6 fmol/mL) (P<0.01). The NT-proBNP levels in mild, moderate and severe HIE neonates were 141.3±41.6, 271.8±118.1 and 347.2±85.1 fmol/mL, respectively. Compared with the control group, the NT-proBNP levels in the moderate and the severe HIE groups significantly increased (P<0.01). There were significant differences in the NT-proBNP level among the mild, moderate and severe HIE groups (P<0.05). In patients with myocardial injury, the NT-proBNP levels significantly decreased in the convalescent phase compared with those in the acute phase (225.0±80.0 fmol/mL vs 338.8±76.2 fmol/mL (P<0.01). CONCLUSIONS: Plasma NT-proBNP levels increase in neonates with HIE complicated by myocardial ischemic injury in the acute phase. Detection of NT-proBNP levels may be useful in the diagnosis of myocardial ischemic injury and the severity evaluation of HIE.［Chin J Contemp Pediatr, 2009, 11 (12):973-975］