脑钠肽和氨基末端脑钠肽在小儿先天性心脏病心功能评估中的价值

Values of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide in evaluation of cardiac function in children with congenital heart disease

摘要:

目的：探讨脑钠肽（BNP）和氨基末端脑钠肽（NT-proBNP）在小儿先天性心脏病心功能评估中的价值。方法：71例先天性心脏病患儿分为无心力衰竭组和心衰组；35例正常儿童作为对照组。应用微粒子酶免疫分析法和电化学发光法分别测定血浆BNP和NT-proBNP浓度。同时测定左室舒张末期内径指数（LVEDDI）、左室射血分数（LVEF）。结果：心衰组血浆BNP和NT-proBNP水平明显高于无心衰组(均P<0.01)；无心衰组血浆BNP和NT-proBNP水平明显高于对照组(均P<0.01) 。心衰组血浆LogBNP和LogNT-proBNP水平与LVEF均呈负相关(r=-0.64，-0.67，均P<0.01)；二者水平与LVEDDI均呈正相关（r=0.58，0.76，均P<0.01）。无心衰组血浆LogBNP和LogNT-proBNP水平与LVEF均无明显相关性；血浆LogNT-proBNP水平与LVEDDI呈正相关（r=0.35，P<0.05）。分别以BNP≥149.8 pg/mL，NT-proBNP≥820.1 pg/mL作为充血性心力衰竭的诊断阈值，二者的敏感度分别为87.0％，91.3％，特异度分别为91.7％，97.9％，ROC曲线下面积分别为0.935，0.987。结论：BNP和NT-proBNP均可用于先天性心脏病患儿心功能的评估，并可用于该类患儿充血性心力衰竭的诊断；与BNP比较，NT-proBNP诊断心衰的价值更高。［中国当代儿科杂志，2009，11（6）：429-432］

Abstract:

OBJECTIVE: To study the values of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the evaluation of cardiac function in children with congenital heart disease (CHD). METHODS: Seventy-one children with CHD were classified to two groups: congestive heart failure (CHF) (n=23 ) and non-CHF (n=48). Thirty-five age-matched normal children were used as the control group. Plasma BNP content was measured using a microparticle enzyme immunoassay (MEIA) on the AxSYM. Plasma NT-proBNP content was measured using an automated electrochemiluminescence immunoassay on a Roche Modular Analytics E170 analyzer. Echocardiographic parameters, including left ventricular end diastolic dimension index (LVEDDI) and left ventricular ejection fraction (LVEF), were measured. RESULTS: Plasma BNP and NT-proBNP contents in the CHF group were significantly higher than those in the non-CHF group (P<0.01). The non-CHF group had higher plasma BNP and NT-proBNP contents than the control group (P<0.01). LogBNP and LogNT-proBNP values were negatively correlated with the LVEF in the CHF group (r=-0.64, r=-0.67 respectively, P<0.01), and they were positively correlated with the LVEDDI (r=0.58, r=0.76 respectively, P<0.01). In the non-CHF group, LogBNP and LogNT-proBNP values were not correlated with the LVEF, but a positive correlation was found between the LogNT-proBNP value and the LVEDDI (r=0.35, P<0.05). Using plasma BNP content ≥149.8 pg/mL and NT-proBNP content ≥820.1 pg/mL as cut-off values for diagnosing CHF respectively, the sensitivities were 87.0 % and 91.3% respectively, the specificities were 91.7% and 97.9% respectively, and the areas under the ROC curves were 0.935 and 0.987 respectively. CONCLUSIONS: Both BNP and NT-proBNP can be useful in assessment of cardiac function and diagnosis of CHF in children with CHD. NT-proBNP appears to be more sensitive and specific in the diagnosis of CHF than BNP.［Chin J Contemp Pediatr, 2009, 11 (6):429-432］