2020 年第 4 期 第 15 卷

心力衰竭新生儿血浆B型脑钠肽和N末端B型脑钠肽前体水平检测的临床意义

Clinical significance of plasma B-type brain natriuretic peptide and N-terminal pro-brain natriuretic peptide in neonates with heart failure

作者：林春秋蒋文秀邱婷邓国清

英文作者：Lin Chunqiu Jiang Wenxiu Qiu Ting Deng Guoqing

单位：成都医学院第一附属医院儿科610500

英文单位：Department of Pediatrics the First Affiliated Hospital of Chengdu Medical College Chengdu 610500 China

关键词：心力衰竭；新生儿；B型脑钠肽；N末端B型脑钠肽前体；诊断；预后

英文关键词：Heartfailure;Neonate;B-typebrainnatriureticpeptide;N-terminalpro-B-typebrainnatriureticpeptide;Diagnosis;Prognosis

• 摘要：

• 【摘要】目的    探讨检测心力衰竭新生儿血浆B型脑钠肽(BNP)和N末端B型脑钠肽前体(NT-proBNP)水平的临床意义。方法    随机选取2017年9月至2019年2月于成都医学院第一附属医院诊治的90例心力衰竭新生儿作为观察组，另选取本院同期60例健康新生儿作为对照组。积极对心力衰竭患儿进行治疗，分别于治疗前及治疗第3、7、14天时检测血浆BNP和NT-proBNP水平，监测心功能，并计算尿量。比较单独检测血浆BNP、NT-proBNP及二者联合检测诊断心力衰竭的临床敏感度、特异度、误诊率、漏诊率、阳性预测值、阴性预测值及准确率。结果    观察组治疗前血浆BNP和NT-proBNP水平均明显高于对照组［（830±208）ng/L比（126±28）ng/L、（6 038±1 573）ng/L比（58±19）ng/L］，左心输出量、右心输出量及尿量均明显低于对照组［（0.39±0.06）L/min比（0.57±0.07）L/min、（0.66±0.10）L/min比（0.89±0.12）L/min、（0.81±0.13）ml/(kg·h)比（2.10±0.23）ml/(kg·h)］，差异均有统计学意义（均P＜0.001）。观察组治疗第3、7、14天时血浆BNP和NT-proBNP水平明显低于治疗前，左心输出量、右心输出量及尿量明显高于治疗前，且随着时间的推移，以上指标逐渐明显恢复，差异均有统计学意义（均P＜0.05）。单纯检测血浆BNP、NT-proBNP的敏感度、特异度、误诊率、漏诊率、阳性预测值、阴性预测值及准确率差异均无统计学意义（均P＞0.05）；二者联合检测的敏感度（96.77%）、特异度（85.71%）、阳性预测值（93.75%）、阴性预测值（92.31%）、准确率（93.33%）均明显高于而误诊率（14.29%）和漏诊率（3.23%）明显低于单独检测BNP和NT-proBNP（均P＜0.001）。结论    检测心力衰竭新生儿血浆BNP和NT-proBNP水平可较好地反映病情，对临床诊治具有指导价值。联合检测BNP和NT-proBNP有利于提高诊断准确性。

• 【Abstract】Objective    To investigate the clinical significance of detecting plasma B-type brain natriuretic peptide(BNP) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in neonates with heart failure. Methods    Ninety neonates with heart failure admitted to the First Affiliated Hospital of Chengdu Medical College from September 2017 to February 2019 were enrolled as observation group and 60 healthy newborns were enrolled as control group. Plasma BNP and NT-proBNP were detected before and the 3rd, 7th, 14th day of treatment. Cardiac function was monitored and urinary production was recorded during treatment. Sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, positive predictive value, negative predictive value and accuracy of BNP, NT-proBNP and joint detection in diagnosing heart failure were analyzed. Results    Before treatment, levels of plasma BNP and NT-proBNP in observation group were significantly higher but left heart output, right heart output and urinary volume were lower than those in control group［（830±208）ng/L vs （126±28）ng/L, （6 038±1 573）ng/L vs （58±19）ng/L, （0.39±0.06）L/min vs （0.57±0.07）L/min, （0.66±0.10）L/min vs （0.89±0.12）L/min, （0.81±0.13）ml/(kg·h) vs （2.10±0.23）ml/(kg·h)］（all P＜0.001）. In observation group, levels of plasma BNP and NT-proBNP decreased but left heart output, right heart output and urinary volume increased at the 3rd, 7th, 14th day of treatment as compared with those before treatment（all P＜0.05）. Sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, positive predictive value, negative predictive value and accuracy in diagnosing neonatal heart failure were similar between BNP and NT-proBNP（all P＞0.05）; the joint detection could significantly enhance the diagnostic sensitivity（96.77%）, specificity（85.71%）, positive predictive value（93.75%）, negative predictive value（92.31%）， accuracy（93.33%）, and reduce misdiagnosis rate（14.29%） and missed diagnosis rate（3.23%）（all P＜0.001）. Conclusions    Plasma BNP and NT-proBNP can reflect the severity of neonatal heart failure and provide guidance for clinical diagnosis and treatment. Joint detection of them can improve the diagnostic accuracy.