N端脑钠肽原和糖原磷酸化酶同工酶BB在新生儿窒息合并心肌损伤中的变化

Plasma levels of N-terminal pro-brain natriuretic peptide and glycogen phosphorylase isoenzyme BB in neonates with asphyxia complicated by myocardial injury

摘要:

目的：探讨N端脑钠肽原(N-terminal pro-brain natriuretic peptide, NT-proBNP )和糖原磷酸化酶同工酶BB (glycogen phosphorylase isoenzyme BB , GPBB)在新生儿窒息合并心肌损伤中的变化及其临床意义。方法：随机选择64例窒息患儿为研究对象（轻度窒息39例,重度窒息25例，其中心肌损伤30例，非心肌损伤34例），以25例正常新生儿为对照组。采用酶联免疫吸附法（ELISA）测定血浆NT-proBNP 和GPBB水平，同时检测心肌酶、肌钙蛋白I、心电图、X线胸片等。结果：心肌损伤组血浆NT-proBNP 和GPBB水平均明显高于非心肌损伤组和对照组（P<0.01）。重度窒息组血浆NT-proBNP 和GPBB水平明显高于轻度窒息组和对照组（P<0.01）。Spearman秩相关分析显示，窒息患儿血浆NT-proBNP 水平与GPBB、CK-MB、CK、LDH呈显著正相关（P<0.01）；GPBB水平与CK-MB、CK、LDH呈显著正相关（P<0.01）。结论： NT-proBNP 和GPBB均可作为窒息新生儿早期心肌损害的生化标志物，联合检测NT-proBNP 和GPBB对于早期发现窒息合并心肌损伤、判断病情程度、指导治疗具有重要的临床意义。［中国当代儿科杂志，2010，12（4）：252-255］

Abstract:

OBJECTIVE: To investigate the changes and the clinical significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and glycogen phosphorylase isoenzyme BB (GPBB) levels in neonates with asphyxia complicated by myocardial injury. METHODS: Sixty-four neonates with asphyxia (39 mild, 25 severe) were enrolled. Of the 64 neonates, 30 had myocardial injury and 34 did not develop myocardial injury. Twenty-five healthy neonates served as a control group. Plasma levels of NT-proBNP and GPBB were measured using ELISA. Myocardial enzymes and cardiac troponin I were stimultaneously measured, and electrocardiography and chest radiographs were obtained. RESULTS: The plasma levels of NT-proBNP and GPBB in neonates with myocardial injury were significantly higher than those in neonates without myocardial injury and in the control group (P<0.01). The neonates with severe asphyxia had significantly increased plasma NT-proBNP and GPBB concentrations compared to those with mild asphyxia and the control group (P<0.01). Spearman rank correlation analysis showed that plasma NT-proBNP level was positively correlated with plasma GPBB level in neonates with asphyxia. Plasma levels of NT-proBNP and GPBB were also positively correlated with plasma levels of CK-MB, CK and LDH (P<0.01). CONCLUSIONS: Both NT-proBNP and GPBB can be used as biomarkers of myocardial injury in neonates with asphyxia .The measurement of plasma NT-proBNP and GPBB levels was useful in early identification of myocardial injury and severity evaluation in neonates with asphyxia.［Chin J Contemp Pediatr, 2010, 12 (4):252-255］