血清脑钠肽检测在小儿甲亢性心脏病中的诊断价值

Value of serum brain natriuretic peptide in the diagnosis of hyperthyroid heart disease in children

摘要:

目的：探讨血清脑钠肽（BNP）检测在小儿甲亢性心脏病（甲亢心）中的诊断价值。方法：测定并比较甲亢心28例（甲亢心组），甲状腺功能亢进症（甲亢组）及对照组各30例小儿的血清BNP、左室射血分数（LVEF），二尖瓣血流频谱E/A比值等指标，并以BNP为诊断指标，对小儿甲亢心进行诊断试验评价。结果：①甲亢心组和甲亢组患儿治疗前血清BNP水平均显著高于对照组（P<0.05），LVEF及E/A比值明显低于对照组（P<0.05），甲亢心组血清BNP水平与TT3、TT4水平呈显著正相关（r=0.801，P<0.05；r=0.578，P<0.05），与LVEF、E/A比值呈显著负相关（r=-0.4８，P<0.05，r=-0.35，P<0.05）。②甲亢心组和甲亢组患儿治疗3个月后血清BNP、TT3、TT4显著低于治疗前（P<0.05），LVEF、E/A比值显著高于治疗前（P<0.05）。③以BNP>323.62 pg/mL为界点诊断甲亢心的灵敏度为92.86%、特异度90.00%、阳性预测值89.66%、阴性预测值93.10%。结论：血清BNP检测是小儿甲亢心比较可靠的诊断指标，其水平的高低结合LVEF、E/A比值可反映甲亢心的严重程度以及心肌损害的程度。［中国当代儿科杂志，2009，11（8）：631-634］

Abstract:

OBJECTIVE: To evaluate the value of serum brain natriuretic peptide (BNP) in the diagnosis of hyperthyroid heart disease in children. METHODS: Fifty-eight children with hyperthyroidism were assigned to two groups according to their cardiac functions: hyperthyroid heart disease (n=28) and hyperthyroidism alone (n=30). Thirty healthy children served as the control group. Serum BNP level, left ventricular ejection fraction (LVEE) and E/A ratio were measured before and after treatment. The diagnostic value of BNP was evaluated in children with hyperthyroid heart disease. RESULTS: The serum BNP level in the hyperthyroid heart disease and the hyperthyroidism alone groups before treatment was significantly higher than that in the control group (P<0.05), while the LVEF and the E/A ratio were significantly lower than those in the control group (P<0.05). Serum BNP level was positively correlated with the TT3 (r=0.801, P<0.05) and TT4 levels (r=0.578, P<0.05) and negatively with the LVEF (r=-0.48, P<0.05) and the E/A ratio (r=-0.35, P<0.05) in the hyperthyroid heart disease group. The serum BNP, TT3 and TT4 levels in the hyperthyroid heart disease and the hyperthyroidism alone groups were reduced and the LVEF and the E/A ratio increased significantly three months after treatment (P<0.05). When serum BNP level of >323.62 pg/mL was proposed as a cutoff point, the sensitivity, specificity, positive predictive value and negative predictive value were 92.86%, 90.00%, 89.66% and 93.10% respectively for the diagnosis of hyperthyroid heart disease. CONCLUSIONS: BNP may serve as a reliable marker for the diagnosis of hyperthyroid heart disease in children. Serum BNP level along with the LVEF and the E/A ratio may be useful in the evaluation of the severity and the cardiac function in children with this disease.［Chin J Contemp Pediatr, 2009, 11 (8):631-634］