2019 年第 1 期 第 14 卷

超声右心功能指标及B型脑钠肽在小儿心脏病合并肺动脉高压临床诊断中的应用价值

Application of echocardiographic right ventricular function indexes and brain natriuretic peptide in clinical diagnosis of pediatric heart disease complicated with pulmonary artery hypertension

作者：郑植唐晶晶彭媛

英文作者：

单位：610041成都天使儿童医院儿科

英文单位：

关键词：小儿心脏病；肺动脉高压；超声检查；右心功能；B型脑钠肽

英文关键词：

• 摘要：

• 【摘要】目的    探究超声右心功能指标及B型脑钠肽在小儿心脏病合并肺动脉高压临床诊断中的应用价值。方法    选取2017年2月至2018年3月四川省人民医院收治的110例心脏病合并肺动脉高压患儿及同期体检的40名健康儿童作为研究对象，根据患儿肺动脉高压的严重程度分为轻度组（49例）、中度组（39例）和重度组（22例），健康儿童设为对照组。检测并比较4组的超声右心功能指标和B型脑钠肽水平。结果    重度组的Tei指数明显高于对照组、轻度组、中度组［（0.46±0.14）比（0.31±0.05）、（0.32±0.06）、（0.33±0.08）］（P＜0.05），其他3组之间Tei指数差异无统计学意义（P＞0.05）；对照组、轻度组、中度组、重度组的肺-体循环血流量比值（Qp/Qs）和B型脑钠肽水平呈逐渐升高趋势［（1.6±0.3）、（2.4±0.4）、（3.0±0.4）、（3.4±0.4）， （33±4）、（59±8）、（104±13）、（147±18）μg/L］，右心室变化率（FAC）呈逐渐降低趋势［（53±5）%、（45±4）%、（36±6）%、（30±6）%］，各组间比较差异均有统计学意义（均P＜0.05）。结论    心脏病合并肺动脉高压患儿的超声右心功能指标和B型脑钠肽水平与健康儿童具有明显差异，能够为临床诊断提供有力依据。随着肺动脉高压严重程度的增加，Qp/Qs和B型脑钠肽水平逐渐升高，FAC水平逐渐降低，能够为病情诊断和严重程度区分提供依据。

• 【Abstract】Objective    To analyze the diagnostic values of echocardiographic right ventricular function indexes and brain natriuretic peptide in children with heart disease complicated with pulmonary artery hypertension. Methods    From February 2017 to March 2018, 110 children with heart disease complicated with pulmonary artery hypertension and 40 healthy children were enrolled in Sichuan Provincial People′s Hospital. According to the severity of pulmonary hypertension, 110 heart disease children were divided into mild group（n＝49）, moderate group（n＝39） and severe group（n＝22）; 40 healthy children were control group. Right ventricular function indexes of echocardiography and brain natriuretic peptide level were analyzed. Results    Tei index in the severe group was higher than that in the control group, mild group and moderate group［（0.46±0.14） vs （0.31±0.05）,（0.32±0.06）,（0.33±0.08）］（P＜0.05）; there were no significant difference between the control, mild and moderate groups(P＞0.05). Pulmonary to systemic blood flow ratio（Qp/Qs） and level of serum brain natriuretic peptide showed significant rising trends among the control group, mild group, moderated group and severe group［（1.6±0.3）,（2.4±0.4）,（3.0±0.4）,（3.4±0.4）; （33±4）,（59±8）,（104±13）,（147±18）μg/L］; fractional area change（FAC） showed a declining trend among the four groups［（53±5）%,（45±4）%,（36±6）%,（30±6）%］（all P＜0.05）. Conclusions    Echocardiographic right ventricular function indexes and brain natriuretic peptide level in children with heart disease combined with pulmonary hypertension show significant differences compared to those in healthy children, which may provide references for the clinical diagnosis. Brain natriuretic peptide level and Qp/Qs increase and FAC decreases with the severity of pulmonary hypertension.