Abstract：OBJECTIVE: Some research has shown that B-type brain natriuretic peptide (BNF) is helpful in differentiating cardiac from pulmonary etiologies of dyspnea in adults. This study was designed to investigate whether BNP concentration could be similarly applied in children presenting with dyspnea. METHODS: Blood samples were collected from 65 children presenting with dyspnea, due to congestive heart failure (CHF, n=24), pneumonia (n=23) or pneumonia together with CHF (n=18). The samples from 15 healthy children were used as the controls. There were no significant differences in age among the four groups. Serum BNP levels were measured using ELISA. RESULTS: Serum BNP levels in the CHF group (141.55±75.99 pg/mL) were significantly higher than those in the Pneumonia group (26.00± 14.57 pg/mL ; P<0.01), and the Pneumonia together with CHF group (113.73±87.05 pg/mL; P<0.05), as well as the Control group (19.31±10.30 pg/mL; P<0.01). The patients with pneumonia together with CHF had significantly higher serum BNP levels than those of the Pneumonia and the Control groups (P<0.01). There were no significant differences in BNP levels between the Pneumonia and the Control groups. The area under the receive operator characteristic (ROC) curve, which demonstrated the diagnostic utility of BNP in differentiating CHF from pneumonia, was 0.978 ( P<0.01 ). At a cut-off of 49 pg/mL, BNP had a sensitivity of 87.5% and a specificity of 95.8% for differentiating CHF from pneumonia. In the 18 patients who were diagnosed with pneumonia together with CHF, 11 had BNP levels above 49 pg/mL . The mean levels of BNP of the 11 patients were significantly higher than those of the patients with pneumonia (172.08± 56.47 pg/mL vs 25.00±14.57 pg/mL; P<0.01) but were significantly decreased after treatment (26.12±15.71 pg/mL; P<0.01 ). CONCLUSIONS: BNP level is of value in differentiating cardiac from pulmonary causes of dyspnea in children. BNP level is also helpful in assessing whether or not severe pneumonia couples with heart failure in children.
AN Jin-Dou,ZHANG Yan-Ping,ZHOU Jian-Hua. Levels of serum brain natriuretic peptide in children with congestive heart failure or with severe pneumonia[J]. CJCP, 2006, 8(3): 201-204.
