目的 探讨氨基末端脑钠肽前体(NT-proBNP)预测早产儿症状性动脉导管未闭(sPDA)的价值。方法 选择2014年6月至2015年4月出生、胎龄≤32周、48 h内超声心动图确定存在动脉导管的早产儿为研究对象,监测其临床表现,于生后3 d及5 d检测血清NT-proBNP水平并行超声心动图检查,根据患儿临床表现、超声心动图结果分为sPDA组及非症状性动脉导管未闭(asPDA)组,分析血清NT-proBNP水平与超声指标的关系,比较两组间相同日龄血清NT-proBNP水平,ROC曲线确定血清NT-proBNP水平预测sPDA的敏感性、特异性。结果 共69例早产儿纳入研究,其中sPDA组13例,asPDA组56例。血清NT-proBNP水平与动脉导管管径、左房内径与主动脉根部内径比值(LA/AO)呈正相关关系(分别r=0.856、0.713,均 P<0.05);生后3 d、5 d,sPDA组血清NT-proBNP水平均高于asPDA组,差异有统计学意义(P<0.05)。生后3 d 血清NT-proBNP水平预测sPDA的ROC曲线下面积为0.949(95%CI:0.892~1.000,P<0.001),临界值为27 035 pg/mL,敏感度为92.3%,特异度为94.6%;生后5 d血清 NT-proBNP水平预测sPDA的ROC曲线下面积为0.924(95%CI:0.848~1.000,P<0.001),临界值为6 411 pg/mL,敏感度为92.3%,特异度为92.9%。结论 NT-proBNP可能是动脉导管分流量的量化指标;生后3 d 及5 d血清NT-proBNP水平的检测均有助于早期预测sPDA。
Abstract
Objective To study the value of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting symptomatic patent ductus arteriosus (sPDA) in preterm infants. Methods Preterm infants born at a gestational age (GA) of ≤32 weeks and diagnosed with patent ductus arteriosus (PDA) by echocardiography within 48 hours after birth between June 2014 and April 2015 were selected as subjects. Their clinical manifestations were observed, and serum NT-proBNP levels were measured and echocardiography was performed at 3 and 5 days after birth. The infants were divided into sPDA group and asymptomatic PDA (asPDA) group based on their clinical manifestations and the results of echocardiography. The correlations between serum NT-proBNP level and echocardiographic indices were analyzed. Serum NT-proBNP levels were compared between the two groups. The receiver operator characteristic (ROC) curve was applied to determine the sensitivity and specificity of serum NT-proBNP in the prediction of sPDA. Results A total of 69 preterm infants were enrolled in this study, with 13 infants in the sPDA group and 56 infants in the asPDA group. Serum NT-proBNP level was positively correlated with the diameter of the arterial duct (r=0.856; P<0.05)and the ratio of left atrial diameter to aortic root diameter (LA/AO) (r=0.713; P<0.05). At 3 and 5 days after birth, the serum NT-proBNP levels in the sPDA group were significantly higher than those in the asPDA group (P<0.05). The area under the ROC curve (AUC) for the prediction of sPDA by NT-proBNP levels at 3 days after birth was 0.949 (95% CI: 0.892-1.000; P<0.001), with a cut-off value of 27 035 pg/mL (sensitivity: 92.3%; specificity: 94.6%); the AUC for the prediction of sPDA by NT-proBNP levels at 5 days after birth was 0.924 (95% CI: 0.848-1.000; P<0.001), with a cut-off value of 6 411 pg/mL (sensitivity: 92.3%; specificity: 92.9%). Conclusions NT-proBNP may be a quantitative index for shunt volume. The measurement of serum NT-proBNP levels on 3 and 5 days after birth may be useful to predict sPDA in preterm infants.
关键词
动脉导管未闭 /
氨基末端脑钠肽前体 /
早产儿
Key words
Patent ductus arteriosus /
NT-proBNP /
Preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 陈涵强, 杨文庆, 杨长仪. 早产儿动脉导管未闭危险因素临床分析[J]. 中国新生儿科杂志, 2010, 25(1): 24-27.
[2] Sellmer A, Bjerre JV, Schmidt MR, et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3[J]. Arch Dis Child Fetal Neonatal Ed, 2013, 98(6): F505-F510.
[3] Kim JS, Shim EJ. B-type natriuretic peptide assay for the diagnosis and prognosis of patent ductus arteriosus in preterm infants[J]. Korean Circ J, 2012, 42(3): 192-196.
[4] Mine K, Ohashi A, Tsuji S, et al. B-type natriuretic peptide for assessment of haemodynamically significant patent ductus arteriosus in premature infants[J]. Acta Paediatr, 2013, 102(8): e347-e352.
[5] Choi BM, Lee KH, Eun BL, et al. Utility of rapid B-type natriuretic peptide assay for diagnosis of symptomatic patent ductus arteriosus in preterm infants[J]. Pediatrics, 2005, 115(3): e255-e261.
[6] 张茜, 罗成汉, 王健. N端脑钠肽前体对新生儿心力衰竭的早期诊断价值[J]. 实用儿科临床杂志, 2010, 25(6): 419-420.
[7] NT-proBNP临床应用中国专家共识小组. NT-proBNP临床应用中国专家共识[J]. 中国心血管研究, 2011, 9(6): 401-408.
[8] 王野峰, 黄希勇. 脑钠肽和氨基末端脑钠尿肽原在儿童心血管疾病诊治中的进展[J]. 中国当代儿科杂志, 2012, 14(6): 470-474.
[9] Malviya MN, Ohlsson A, Shah SS. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants[J]. Cochrane Database Syst Rev, 2013, 3: CD003951.
[10] Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant[J]. Pediatrics, 2010, 125(5): 1020-1030.
[11] Schneider DJ, Moore JW. Patent ductus arteriosus[J]. Circulation, 2006, 114(17): 1873-1882.
[12] Suzumura H, Nitta A, Tanaka G, et al. Diastolic flow velocity of the left pulmonary artery of patent ductus arteriosus in preterm infants[J]. Pediatr Int, 2001, 43(2): 146-151.
[13] Engur D, Deveci M, Turkmen MK. Early signs that predict later haemodynamically significant patent ductus arteriosus[J]. Cardiol Young, 2015 [Epub ahead of print].
[14] Harling S, Hansen-Pupp I, Baigi A, et al. Echocardiographic prediction of patent ductus arteriosus in need of therapeutic intervention[J]. Acta Paediatr, 2011, 100(2): 231-235.
[15] Martinovici D, Vanden ES, Unger P, et al. Early NT-proBNP is able to predict spontaneous closure of patent ductus arteriosus in preterm neonates, but not the need of its treatment[J]. Pediatr Cardiol, 2011, 32(7): 953-957.
[16] Buddhe S, Dhuper S, Kim R, et al. NT-proBNP levels improve the ability of predicting a hemodynamically significant patent ductus arteriosus in very low-birth-weight infants[J]. J Clin Neonatol, 2012, 1(2): 82-86.
[17] 时赞扬,张茜. B型利钠肽及氨基末端脑钠肽前体水平与早产儿疾病相关性研究进展[J]. 中华临床医师杂志(电子版), 2013, 7(8): 3490-3493.
[18] Mir TS, Laux R, Hellwege HH, et al. Plasma concentrations of aminoterminal pro-atrial natriuretic peptide and aminoterminal pro-brain natriuretic peptide in healthy neonates: marked and rapid increase after birth[J]. Pediatrics, 2003, 112(4): 896-899.
[19] Ramakrishnan S, Heung YM, Round J, et al. Early N-terminal pro-brain natriuretic peptide measurements predict clinically significant ductus arteriosus in preterm infants[J]. Acta Paediatr, 2009, 98(8): 1254-1259.
基金
广东省医学科学技术研究基金项目(B2015084)。
PDF(1131 KB)
