婴幼儿先天性心脏病术前氨基末端B型脑利钠肽前体检测的临床意义

Clinical importance of preoperative measurement of plasma amino-terminal pro-B-type natriuretic peptide in infants with congenital heart disease

摘要:

目的 检测婴幼儿先天性心脏病（CHD）术前血浆氨基末端B型脑利钠肽前体（NT-proBNP），探寻CHD患儿术前合并充血性心力衰竭（CHF）血浆NT-proBNP诊断界值，对术前心功能维护的效果进行评价。方法 测定2010年6月至2013年6月收治的120例术前婴幼儿CHD患儿及100例正常儿童（对照组）血浆NT-proBNP水平，将合并CHF的CHD患儿（CHF组）又分为婴儿组（<1岁）和幼儿组（≥1岁），探寻NT-proBNP在不同年龄段CHF患儿中诊断CHF的界值。结果 120例婴幼儿CHD中41例符合改良Ross心力衰竭诊断标准，CHF组NT-proBNP诊断CHF界值为≥498 ng/L，婴儿组和幼儿组的NT-proBNP诊断CHF界值分别为557 ng/L、452 ng/L。41例CHF患儿经治疗后NT-proBNP较治疗前明显下降，其差异有统计学意义（P<0.001）。结论 婴儿组与幼儿组的NT-proBNP诊断CHF的界值存在明显差异。血浆NT-proBNP可作为CHD婴幼儿术前心功能评估的一个指标。

Abstract:

Objective To define cut-off values of plasma amino-terminal pro-B-type natriuretic peptide (NT-ProBNP) for the diagnosis of congenital heart failure (CHF) and evaluate the importance of plasma NT-ProBNP measurement in the assessment of cardiac function prior to heart surgery in infants with congenital heart disease (CHD). Methods Plasma levels of NT-proBNP were measured in 120 infants with CHD before heart surgery and in 100 age-matched healthy infants between June 2010 and June 2013. The data were stratified based on the presence or absence of CHF in the whole group of CHD infants and on age (i.e., <1 year and ≥1 year) and time (i.e., before surgery) within the subgroup of CHF infants. Results Of the 120 infants with CHD, 41 met the criteria for CHF defined in the Ross Classification for Heart Failure in Infants.The cut-off values of plasma NT-ProBNP were ≥498 ng/L for infants of all ages, 557 ng/L for <1 year age group and 452 ng/L for ≥1 year age group, respectively, in the 41 CHF patients. In CHF infants, plasma NT-proBNP was significantly decreased after protecting of cardiac function (P<0.001). Conclusions The cut-off values of plasma NT-ProBNP for CHF differ between infants <1 year and infants ≥1 year. Moreover, plasma NT-ProBNP can be used as an additional parameter in the preoperative assessment of cardiac function in CHD infants.