BNP及NT-proBNP对室间隔缺损合并心力衰竭诊断价值的研究

发布时间：2018-07-06 18:34

  本文选题：室间隔缺损 + 心力衰竭　； 参考：《皖南医学院》2017年硕士论文

【摘要】：目的:室间隔缺损(Ventricular Septal Defect,VSD)是小儿最常见的先天性心脏病,终末期易导致充血性心力衰竭(Congestive heart failure,CHF),若不及时诊治,病死、病残率极高。本研究通过对VSD合并心衰患儿血浆脑利钠肽(Brain Natriuretic Peptide,BNP)及其氨基末端B型利钠肽前体(N-ter-minal pro-B-type natriuretic peptide,NT-pro BNP)水平与超声影像资料、临床评估标准的关系进行分析,旨在探讨血浆BNP及NT-pro BNP在评价VSD患儿心功能中的价值,以探索建立小儿VSD合并CHF的生物学诊断指标。方法:选取2015.03-2016.12我院门诊就诊及住院治疗的室间隔缺损患儿80例作为实验组,所有患儿均排除中枢神经、内分泌及免疫系统疾病,且肝肾功能均无异常。同时选取15例于我院门诊体检的健康儿童作为正常对照组。分别测定各组患儿左室舒张末期容量指数(LVEDVI)、左室收缩末期室壁应力(LVESWS)、左室缩短分数(LVFS)、左室射血分数(LVEF),根据超声心动图结果将实验组患儿分为心衰组48例及无心衰组32例;应用ELISA方法测定各组患儿血浆BNP及NT-pro BNP浓度。并选取小儿常用心衰诊断标准(如改良Ross标准、NYU PHFI标准)对80例VSD患儿进行评分分级。结果:1.心衰组患儿的LVEDVI、LVESWS水平高于无心衰组和对照组患儿(P0.05);LVEF、LVFS水平低于无心衰组和对照组患儿(P0.05);心衰组患儿BNP及NT-pro BNP水平明显高于无心衰组(均P0.05),无心衰组与正常对照组间差别无统计学意义(均P0.05)。2.VSD患儿血浆BNP水平与NT-pro BNP呈正相关(r=0.933,P0.05)。3.VSD患儿血浆BNP水平与LVESWS(r=0.883,P0.05)、LVEDVI(r=0.868,P0.05)呈正相关,与LVEF(r=-0.751,P0.05)、LVFS(r=-0.527,P0.05)呈负相关;血浆NT-pro BNP水平与LVESWS(r=0.889,P0.05)、LVEDVI(r=0.856,P0.05)呈正相关,与LVEF(r=-0.676,P0.05)、LVFS(r=-0.494,P0.05)呈负相关。4.血浆BNP诊断室缺合并心衰的ROC曲线下面积为0.876,且BNP≥337pg/ml诊断的敏感度为72.9%,特异度为93.7%,95%可信区间为0.802-0.951。血浆NTpro BNP诊断室缺合并心衰的ROC曲线下面积为0.924,NT-pro BNP≥493fmol/ml诊断的敏感度为77.1%,特异度为100.0%,95%可信区间为0.861-0.988。5.改良Ross评分标准诊断室缺合并心衰的ROC曲线下面积为0.862,且当评分≥5分时,诊断的灵敏度为75%,特异度为96.9%,准确率为75%,漏诊率为10%,误诊率为15%,95%可信区间为0.779-0.945。NYU PHFI评分标准诊断室缺合并心衰的ROC曲线下面积达0.870,当评分≥7分时,灵敏度为87.5%,特异度为68.7%,准确率为80%,漏诊率为7.5%,误诊率为12.5%,95%可信区间为0.795-0.946。结论:1.BNP及NT-pro BNP水平可作为VSD合并心衰患儿心功能评估的简便、敏感、有效的生物学指标。2.NT-pro BNP诊断室缺合并心衰的价值优于BNP。
[Abstract]:Objective: ventricular septal defect (VSD) is the most common congenital heart disease in children. It is easy to cause congestive heart failure (CHF) at the end stage. In this study, the relationship between plasma brain natriuretic peptide (Brain natriuretic peptide BNP) and N-minal pro-B-type natriuretic peptide (NT-pro BNP) and ultrasound imaging data and clinical evaluation criteria in children with heart failure were analyzed. Objective to explore the value of plasma BNP and NT-pro BNP in evaluating heart function in children with VSD, and to establish the biological diagnostic index of VSD with CHF in children. Methods: 80 children with ventricular septal defect (VSD) treated in our hospital from May to June, 2015.03-2016.12 were selected as experimental group. All the children were excluded from central nervous system, endocrine and immune system diseases, and no abnormal liver and kidney function was found. At the same time, 15 healthy children were selected as normal control group. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic wall stress (LVESWS), left ventricular shortening fraction (LVFS) and left ventricular ejection fraction (LVEF) were measured. Plasma BNP and NT-pro BNP were measured by Elisa. The common diagnostic criteria of heart failure in children (such as modified Ross standard and NYU PHFI standard) were selected to grade 80 children with VSD. The result is 1: 1. The level of LVEDVI LVESWS in heart failure group was higher than that in no heart failure group and control group (P0.05), the level of BNP and NT-pro BNP in heart failure group was significantly higher than that in heart failure group (P0.05), and the level of BNP and NT-pro BNP in heart failure group was significantly higher than that in no heart failure group and normal control group (P0.05), and the levels of BNP and NT-pro BNP in heart failure group were significantly higher than those in no heart failure group and control group (P0.05). There was no significant difference between plasma BNP levels and NT-pro BNP levels in VSD children (P 0.05). 3. There was a positive correlation between BNP levels in VSD children and LVESWS (r 0.883P 0.05) and LVEDVI (r = 0.868 P 0.05). There was a negative correlation between plasma NT-pro BNP level and LVESWS (rn 0.889U P 0.05) and LVEDVI (r = 0.856P 0.05), and a negative correlation between NT-pro BNP level and LVEF (r + 0.676P 0.05) and LVFS (r + -0.494P 0.05), and a negative correlation between plasma NT-pro BNP level and LVESWS (r + 0.889U P 0.05), and a negative correlation between NT-pro BNP level and LVEF (r + 0.676P 0.05) and LVFS (r + -0.494P 0.05). The area under the ROC curve was 0.876, the sensitivity of BNP 鈮，

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