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

林丽星; 毛庆花; 张志玲; 安彩霞; 康曦光

PDF(1003 KB)

中国当代儿科杂志 ›› 2010, Vol. 12 ›› Issue (04) : 252-255.

论著·临床研究

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

林丽星，毛庆花，张志玲，安彩霞，康曦光

作者信息 +

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

LIN Li-Xing, MAO Qing-Hua, ZHANG Zhi-Ling, AN Cai-Xia, KANG Xi-Guang

Author information +

文章历史 +

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］

导出引用

林丽星, 毛庆花, 张志玲, 安彩霞, 康曦光. 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[J]. 中国当代儿科杂志. 2010, 12(04): 252-255

LIN Li-Xing, MAO Qing-Hua, ZHANG Zhi-Ling, AN Cai-Xia, KANG Xi-Guang. Plasma levels of N-terminal pro-brain natriuretic peptide and glycogen phosphorylase isoenzyme BB in neonates with asphyxia complicated by myocardial injury[J]. Chinese Journal of Contemporary Pediatrics. 2010, 12(04): 252-255

中图分类号： R722.12

参考文献

［1］Kotaska K, Popelova J, Tiserova M, Telekes P, Vrzanova M, Bronsky J, et al. NT-proBNP and BNP values in cardiac patients with different degree of left ventricular systolic dysfunction［J］. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2006, 150(1):125-130.
［2］Peetz D, Post F, Schinzel H, Schweiqert R, Schollmayer C, Steinbach K, et al. Glycogen phosphorylase BB in acute coronary syndromes［J］. Clin Chem Lab Med, 2005, 43(12):1351-1358.
［3］金汉珍,黄德珉,官希吉.实用新生儿学［M］. 第3版.北京:人民卫生出版社, 2003:400-405, 600-603.
［4］曹绪梅, 虞人杰. 围产期缺氧心肌损害的监测及诊断附120例临床研究［J］.中华围产医学杂志, 2005, 8(4):272-273.
［5］Rajakumar PS, Vishnu Bhat B, Sridhar MG, Balachander J, Konar BC, Narayanan P, et al. Electrocardiographic and Echocardiographic changes in perinatal asphyxia［J］.Indian J Pediatr, 2009, 76(3):261-264.
［6］Barbosa MM, Nunes MCP, Ribeiro ALP, Barral MM, Rocha MOC. N-terminal proBNP levels in patients with Chagas disease: A marker of systolic and diastolic dysfunction of the left ventricle［J］.Eur J Echocardiography, 2007, 8:204-212.
［7］Heeschen C, Hamm CW, Mitrovic V, Lantelme NH, White HD. N-Terminal Pro-B-Type Natriuretic Peptide levels for dynamic risk stratification of patients with acute coronary syndromes［J］.Circulation, 2004, 110（8）:3206-3212.
［8］石军.新生儿窒息心脏收缩功能损害的超声心动图观察及临床意义［J］.宁夏医学杂志, 2006, 28(1):27-29.
［9］徐孝华,黄国英,陈超,曹云.新生儿窒息后肺动脉高压对心功能影响的研究［J］.中国实用儿科杂志, 2008, 23(9):667-669.
［10］Stejskal D, Lacnak B, Jedelskv L, Stepanova L, Proskova J, Solichova P, et al. Use of glycogen phosphorylase BB measurement with POCT in the diagnosis of acute coronary syndromes. A comparison with the ELISA method［J］. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2007, 151(2):247-249.
［11］杨雪松,范蓉,王健,朱正美. 糖原磷酸化酶BB型(GPBB)测定在临床中的应用［J］.中华临床医药, 2002, 3(23):31-32.
［12］陈铃,朱红枫,魏洪平,陈桃,陈书琴. 氨基末端脑钠肽和糖原磷酸化酶同工酶脑型对充血性心力衰竭患儿的诊断价值［J］. 实用儿科临床杂志, 2008, 23(13):1008-1010.
［13］Rabitzsch G, Mair J, Lechleitner P, Noll F, Hofmann U, Krause EG, et al. Immunoenzymometric assay of human glycogen phosphorylase isoenzyme BB in diagnosis of ischemic myocardial injury［J］. Clin Chem , 1995, 41(7):966-978.
［14］陈光福，蔡茵莎，刘丽辉，黄铁军.新生儿窒息后心肌肌钙蛋白I与心肌酶活性的时相变化及其意义［J］.中国当代儿科杂志，2002，4（4）：281-284.
［15］孙虹,台虹,王凡,陶瑞,缪红,刘琳. 新生儿窒息后血清心肌肌钙蛋白T和心肌酶检测结果分析［J］.国际检验医学杂志, 2006, 27(7):603-604.