PDF(1082 KB)
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
张慎荣, 张园海, 徐强, 仇慧仙, 陈其
中国当代儿科杂志 ›› 2009, Vol. 11 ›› Issue (06) : 429-432.
PDF(1082 KB)
PDF(1082 KB)
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
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］
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］
脑钠肽 / 氨基末端脑钠肽 / 心力衰竭 / 充血性 / 先天性心脏病 / 儿童
Brain natriuretic peptide / N-terminal pro-brain natriuretic peptide / Heart failure, congestive / Congenital heart disease / Child
［1］Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain［J］. Nature, 1988, 332(6159):78-81.
［2］Morrow DA, de Lemos JA, Blazing MA, Sabatine MS, Murphy SA, Jarolim P, et al. Prognostic value of serial B-type natriuretic peptide testing during follow-up of patients with unstable coronary artery disease［J］. JAMA, 2005, 294(22):2866-2871.
［3］Price JF, Thomas AK, Grenier M, Eidem BW, O′Brian Smith E, Denfield SW, et al. B-type natriuretic peptide predicts adverse cardiovascular events in pediatric outpatients with chronic left ventricular systolic dysfunction［J］. Circulationtion, 2006, 114(10):1063-1069.
［4］Maher KO, Reed H, Cuadrado A, Simsic J, Mahle WT, Deguzman M, et al. B-type natriuretic peptide in the emergency diagnosis of critical heart disease in children［J］. Pediatrics, 2008, 121(6):e1484-e1488.
［5］Aggarwal S, Pettersen MD, Bhambhani K, Gurczynski J, Thomas R, L′Ecuyer T. B-type natriuretic peptide as a marker for cardiac dysfunction in anthracyclinetreated children［J］. Pediatr Blood Cancer, 2007, 49(6):812-816.
［6］Nasser N, Perles Z, Rein AJ, Nir A. NT-proBNP as a marker for persistent cardiac disease in children with history of dilated cardiomyopathy and myocarditis［J］. Pediatr Cardiol, 2006, 27(1):87-90.
［7］褚茂平,徐强,吴蓉洲,荣星,任跃,张园海，等. 小儿肺炎并发心力衰竭时血清脑钠素的变化［J］. 中华急诊医学杂志, 2008, 17(1):76-77.
［8］Reithmann C, Reber D, Kozlik-Feldmann R, Netz H, Pilz G, Welz A, et al. Post-recepter defect of adenylyl cyclase in severely failing myocardium from children with congenital heart disease［J］. Eur J Pharmacol, 1997, 330(1):79-86.
［9］Laer S, Mir TS, Behn F, Eiselt M, Scholz H, Venzke A, et al. Carvedilol therapy in pediatric patients with congestive heart failure: a study investigating clinical and pharmacokinetic parameters［J］. Am Heart J, 2002, 143(5):916-922.
［10］武育蓉,陈树宝,黄美蓉,张玉奇,孙琨,陈笋，等. 氨基末端脑利钠肽前体在室间隔缺损合并力衰竭诊断中的价值［J］. 中华儿科杂志, 2005, 43(3):161-164.
［11］Zile MR, Gaasch WH, Carroll JD, Feldman MD, Aurigemma GP, Schaer GL, et al. Heart failure with a normal ejection fraction:is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure?［J］.Circulation, 2001, 104(7):779-782.
［12］Ng LL, Loke I, Davies JE, Khunti K, Stone M, Abrams KR, et al. Identification of previously undiagnosed left ventricular systolic dysfunction: community screening using natriuretic peptides and electrocardiography［J］. Eur J Heart Fail, 2003, 5(6):775-782.
［13］Hall C. Essential biochemistry and physiology of NT-proBNP［J］. Eur J Heart Fail, 2004, 6(3):257-260.
［14］Yeo KT, Dumont KE, Brough T. Elecsys NT-ProBNP and BNP assays: are there analytically and clinically relevant differences?［J］.J Card Fail, 2005, 11(5 Suppl): s84-s88.
［15］Mir TS, Marohn S, Laer S, Eiselt M, Grollmus O, Weil J, et al. Plasma concentrations of N-terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heart failure［J］. Pediatrics, 2002, 110(6):e76.
［16］Seino Y, Ogawa A, Yamashita T, Fukushima M, Ogata K, Fukumoto H, et al. Application of NT-proBNP and BNP measurements in cardiac care: a more discerning marker for the detection and evaluation of heart failure［J］. Eur J Heart Fail, 2004, 6(3):295-300.
［17］Chien TI, Chen HH, Kao JT. Comparison of Abbott AxSYM and Roche Elecsys 2010 for measurement of BNP and NT-proBNP［J］. Clin Chim Acta, 2006, 369(1):95-99.
［18］安金斗，张彦萍，周建华.充血性心力衰竭与重症肺炎患儿血清脑钠素浓度变化的研究［J］.中国当代儿科杂志，2006，8（3）：201-204.
