氨基末端脑钠肽前体对婴儿期左向右分流型先天性心脏病心功能评估的临床应用价值
发布时间：2018-11-29 13:36
【摘要】：目的通过探讨婴儿期左向右分流型先天性心脏病(Congenital Heart Disease,CHD)患儿合并心力衰竭(Heart Failure,HF)时血浆氨基末端脑钠肽前体(N-Terminal pro-Brain Natriuretic Peptide,NT-pro BNP)水平的变化情况,结合此类患儿合并HF时临床心功能的的评估,分析血浆NT-pro BNP与改良Ross评分之间的相关性,并绘制受试者工作特征(Receiver Operating Characteristic,ROC)曲线,寻找婴儿期左向右分流型CHD合并HF时的快速检测手段,找出各心功能分级的HF患儿血浆NT-Pro BNP的诊断截断值,量化HF分级,为婴儿期左向右分流型CHD合并HF时,提供更为客观、简便、实用的HF诊断标准。方法研究组为2015年1月-2016年6月安徽医科大学儿科临床学院心内科收治的54例经超声心动图确诊的左向右分流型CHD患儿,其中包括房间隔缺损(Atrial Septal Defect,ASD)、室间隔缺损(Ventricular Septal Defect,VSD)、动脉导管未闭(Patent Ductus Arteriosus,PDA)。患儿年龄为1月~1岁,平均年龄144±93天,其中男32例,女22例。对照组为经超声心动图排除的无CHD,也无HF症状及肾功能正常的普通呼吸道感染患儿,共12例,其中男8例,女4例,年龄1月~1岁,平均年龄212±127天。研究组患儿根据改良Ross评分法将研究组进行HF分级,其中无HF者13例,轻度HF者15例,中度HF者13例,重度HF者13例。所有研究组及对照组患儿在入院后抽取外周静脉血,采用美国(罗氏)cobas h232快速心力衰竭诊断仪及同公司相应的罗氏CARDIAC测试条进行检测。检验结果8~12分钟即可测出。结果CHD患儿的血浆NT-pro BNP水平与改良Ross评分成正相关,随改良Ross评分的增大而升高(r=0.85,P0.05)。与对照组相比,左向右分流型CHD患儿血浆NT-pro BNP水平明显增高,差异有统计学意义(P0.05),血浆NT-pro BNP在不同HF分级之间存在明显差异(F=59.68,P0.05),不同程度HF患儿治疗前后血浆NT-pro BNP存在明显差异(P0.05)。通过绘制ROC曲线,得出左向右分流型CHD患儿合并HF时,心功能不全时的血浆NT-pro BNP诊断截断值为286.50pg/m L,诊断轻度HF的截断值为635.50pg/m L,诊断中度HF的截断值为1680.5pg/m L,诊断重度HF的截断值为3863.00pg/m L。结论血浆NT-pro BNP可敏感地反映HF的严重程度,与改良Ross评分成正相关。通过研究得出NT-pro BNP286.50pg/m L时,可作为判断婴儿期左向右分流型CHD患儿心功能不全的诊断截断值,诊断轻度HF的截断值为635.5pg/m L,诊断中度HF患儿的截断值为1680.5pg/m L,重度HF患儿截断值为3863pg/m L,不同心功能分组间治疗前后有明显差异,可作为此类患儿合并HF时,评估治疗效果的重要监测手段。
[Abstract]:Objective to investigate the changes of plasma amino-terminal brain natriuretic peptide (N-Terminal pro-Brain Natriuretic Peptide,NT-pro BNP) levels in infants with left to right shunt congenital heart disease (Congenital Heart Disease,CHD) complicated with heart failure (Heart Failure,HF). The relationship between plasma NT-pro BNP and modified Ross score was analyzed by evaluating the clinical cardiac function of these children with HF, and the operating characteristic (Receiver Operating Characteristic,ROC curve was plotted. To find out the rapid detection method of left to right shunt type CHD combined with HF in infancy, to find out the diagnostic truncation value of plasma NT-Pro BNP in children with HF with different cardiac function grades, and to quantify the HF grade, which is when left to right shunt type CHD is combined with HF in infancy. To provide more objective, simple and practical diagnostic criteria for HF. Methods from January 2015 to June 2016, 54 patients with left to right shunt CHD, including atrial septal defect (Atrial Septal Defect,ASD), were treated in Department of Cardiology, Department of Pediatrics, Anhui Medical University. Ventricular septal defect (Ventricular Septal Defect,VSD), patent ductus arteriosus (Patent Ductus Arteriosus,PDA). The average age was 144 卤93 days, including 32 males and 22 females. The control group consisted of 12 children with normal renal function, including 8 males and 4 females, aged from one month to one year, with an average age of 212 卤127days. According to the modified Ross scoring method, the patients in the study group were graded with HF, including 13 cases without HF, 15 cases with mild HF, 13 cases with moderate HF and 13 cases with severe HF. The peripheral venous blood was taken from all the children in the study group and the control group after admission. The cobas H232 rapid heart failure diagnostic instrument and the corresponding Roche CARDIAC test strip were used to detect the results. The test results can be measured in 812 minutes. Results there was a positive correlation between the plasma NT-pro BNP level and the modified Ross score in children with CHD, which increased with the increase of the modified Ross score (P 0.05). Compared with the control group, the level of plasma NT-pro BNP in patients with left to right shunt type CHD was significantly increased (P0.05), and plasma NT-pro BNP was significantly different among different HF grades (F59.68%, P0.05). There was significant difference in plasma NT-pro BNP before and after treatment in children with HF of different degree (P0.05). By drawing ROC curve, the diagnostic truncation value of plasma NT-pro BNP in patients with left to right shunt type CHD combined with HF was 286.50pg/m L, and that of mild HF was 635.50pg/m L. In the diagnosis of moderate HF, the truncation value was 1680.5pg/m L, and the truncation value of severe HF was 3863.00pg/m L. Conclusion Plasma NT-pro BNP can sensitively reflect the severity of HF and has a positive correlation with the modified Ross score. The results show that NT-pro BNP286.50pg/m L can be used as the diagnostic truncation value of left to right shunt type CHD in infancy, and the truncation value of mild HF is 635.5pg/m L. The truncation value of moderate HF and severe HF was 1680.5pg/m L and 3863pg/m L, respectively. There were significant differences between different heart function groups before and after treatment, which could be used as an important monitoring method for evaluating the therapeutic effect of these children with HF.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4
本文编号：2365135
[Abstract]:Objective to investigate the changes of plasma amino-terminal brain natriuretic peptide (N-Terminal pro-Brain Natriuretic Peptide,NT-pro BNP) levels in infants with left to right shunt congenital heart disease (Congenital Heart Disease,CHD) complicated with heart failure (Heart Failure,HF). The relationship between plasma NT-pro BNP and modified Ross score was analyzed by evaluating the clinical cardiac function of these children with HF, and the operating characteristic (Receiver Operating Characteristic,ROC curve was plotted. To find out the rapid detection method of left to right shunt type CHD combined with HF in infancy, to find out the diagnostic truncation value of plasma NT-Pro BNP in children with HF with different cardiac function grades, and to quantify the HF grade, which is when left to right shunt type CHD is combined with HF in infancy. To provide more objective, simple and practical diagnostic criteria for HF. Methods from January 2015 to June 2016, 54 patients with left to right shunt CHD, including atrial septal defect (Atrial Septal Defect,ASD), were treated in Department of Cardiology, Department of Pediatrics, Anhui Medical University. Ventricular septal defect (Ventricular Septal Defect,VSD), patent ductus arteriosus (Patent Ductus Arteriosus,PDA). The average age was 144 卤93 days, including 32 males and 22 females. The control group consisted of 12 children with normal renal function, including 8 males and 4 females, aged from one month to one year, with an average age of 212 卤127days. According to the modified Ross scoring method, the patients in the study group were graded with HF, including 13 cases without HF, 15 cases with mild HF, 13 cases with moderate HF and 13 cases with severe HF. The peripheral venous blood was taken from all the children in the study group and the control group after admission. The cobas H232 rapid heart failure diagnostic instrument and the corresponding Roche CARDIAC test strip were used to detect the results. The test results can be measured in 812 minutes. Results there was a positive correlation between the plasma NT-pro BNP level and the modified Ross score in children with CHD, which increased with the increase of the modified Ross score (P 0.05). Compared with the control group, the level of plasma NT-pro BNP in patients with left to right shunt type CHD was significantly increased (P0.05), and plasma NT-pro BNP was significantly different among different HF grades (F59.68%, P0.05). There was significant difference in plasma NT-pro BNP before and after treatment in children with HF of different degree (P0.05). By drawing ROC curve, the diagnostic truncation value of plasma NT-pro BNP in patients with left to right shunt type CHD combined with HF was 286.50pg/m L, and that of mild HF was 635.50pg/m L. In the diagnosis of moderate HF, the truncation value was 1680.5pg/m L, and the truncation value of severe HF was 3863.00pg/m L. Conclusion Plasma NT-pro BNP can sensitively reflect the severity of HF and has a positive correlation with the modified Ross score. The results show that NT-pro BNP286.50pg/m L can be used as the diagnostic truncation value of left to right shunt type CHD in infancy, and the truncation value of mild HF is 635.5pg/m L. The truncation value of moderate HF and severe HF was 1680.5pg/m L and 3863pg/m L, respectively. There were significant differences between different heart function groups before and after treatment, which could be used as an important monitoring method for evaluating the therapeutic effect of these children with HF.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4
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