2022 年第 2 期 第 17 卷

血清N末端B型脑钠肽前体水平在新生儿窒息预后评估中的意义

Study on the significance of serum N-terminal pro-brain natriuretic peptide in evaluating the prognosis of neonatal asphyxia

作者：贾延贞1常璠2纪荣祖2李海萍1王晶1尕项卓玛3杨晶1杨成英1刘福星2何兵2 高延可2

英文作者：Jia Yanzhen1 Chang Fan2 Ji Rongzu2 Li Haiping1 Wang Jing1 Gaxiangzhuoma3 Yang Jing1 Yang Chengying1 Liu Fuxing2 He Bing2 Gao Yanke2

单位：1青海省西宁市第三人民医院儿科，西宁810005；2青海省西宁市第三人民医院检验科，西宁810005；3青海省西宁市第三人民医院产科，西宁810005

英文单位：1Department of Pediatrics the Third People′s Hospital of Xining Qinghai Province Xining 810005 China; 2Department of Clinical Laboratory the Third People′s Hospital of Xining Qinghai Province Xining 810005 China; 3Department of Obstetrics the Third People′s Hospital of Xining Qinghai Province Xining 810005 China

关键词：新生儿窒息；N末端B型脑钠肽前体；预后

英文关键词：Neonatalasphyxia;N-terminalpro-brainnatriureticpeptide;Prognosis

• 摘要：

• 目的  探讨血清N末端B型脑钠肽前体(NT-proBNP)水平在新生儿窒息预后评估中的意义。方法  选取2018年1月至2021年2月于西宁市第三人民医院产科分娩的128例窒息患儿，其中轻度窒息78例，重度窒息50例，同时选取62例无窒息及心血管系统疾病的新生儿为对照组。比较轻度、重度窒息患儿与对照组新生儿血清NT-proBNP水平。对128例窒息患儿随访12个月，统计并记录窒息新生儿死亡情况和后遗症发生情况。若患儿死亡或发生后遗症，则纳入预后不良组，若未发生则纳入预后良好组。采用多因素Logistic回归方法分析窒息新生儿预后不良的危险因素，受试者工作特征（ROC）曲线分析NT-proBNP对窒息新生儿预后的预测价值。结果  对照组新生儿血清NT-proBNP水平明显低于轻度、重度窒息患儿［（3 295±618）ng/L比（34 468±5 212）、（43 586±4 529）ng/L］，轻度窒息患儿血清NT-proBNP水平明显低于重度窒息患儿，差异均有统计学意义(均P＜0.05)。早产、妊娠期高血压疾病、宫内窘迫、羊水异常、胎盘早剥、宫缩乏力、Na+＜138.67 mmol/L、Ca2+＜2.23 mmol/L、NT-proBNP≥26 748.61 ng/L是影响窒息新生儿预后不良的独立危险因素(均P＜0.05)。NT-proBNP预测窒息新生儿预后的ROC曲线下面积为0.927(95%置信区间：0.695～0.964，P＜0.001)，最佳临界值为26 729.54 ng/L，特异度为88%，敏感度为91%。结论  血清NT-proBNP水平可反映窒息新生儿窒息严重程度。NT-proBNP≥26 748.61 ng/L是新生儿窒息预后不良的独立危险因素。

• Objective To investigate the significance of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in evaluating the prognosis of neonatal asphyxia. Methods From January 2018 to February 2021, 128 children with asphyxia who were delivered in Department of Obstetrics, the Third People′s Hospital of Xining were selected, including 78 cases of mild asphyxia and 50 cases of severe asphyxia. Meanwhile, 62 neonates without asphyxia and cardiovascular diseases were selected as control group. The serum NT-proBNP level of children with mild and severe asphyxia were compared with that of newborns in the control group. Totally 128 children with asphyxia were followed-up for 12 months. The death and sequelae of asphyxia neonates were counted. The children who died or had sequelae were included in the poor prognosis group, and the rest of them were included in the good prognosis group. Multivariate Logistic regression analysis was used to analyze the risk factors of poor prognosis in asphyxia neonates, and the predictive value of NT-proBNP in the prognosis of asphyxiated neonates was analyzed by receiver operating characteristic (ROC) curve. Results The serum NT-proBNP level of neonates in the control group was significantly lower than that in children with mild and severe asphyxia［（3 295±618）ng/L vs （34 468±5 212）, （43 586±4 529）ng/L］, the serum NT-proBNP level in children with mild asphyxia was significantly lower than that in children with severe asphyxia (all P＜0.05). Premature delivery, pregnancy induced hypertension, intrauterine distress, abnormal amniotic fluid, placental abruption, weakness of uterine contraction, Na+＜138.67 mmol/L, Ca2+＜2.23 mmol/L, NT-proBNP ≥26 748.61 ng/L were independent risk factors for poor prognosis of asphyxia neonates (all P＜0.05). The area under the ROC curve of NT-proBNP in predicting the prognosis of asphyxia neonates was 0.927 (95% confidence interval: 0.695-0.964, P＜0.001), the best critical value was 26 729.54 ng/L, the specificity was 88%, and the sensitivity was 91%. Conclusions The level of serum NT-proBNP can reflect the severity of neonatal asphyxia. NT-proBNP≥26 748.61 ng/L is an independent risk factor for prognosis after neonatal asphyxia.