正常和心力衰竭儿童血清氨基末端脑钠肽的变化

目的测定正常及心力衰竭(HF)患儿血清氨基末端脑钠肽(NT-proBNP)水平,探讨NT-proBNP在HF患儿中的改变及其与HF严重程度的关系,并提供小儿NT-proBNP的正常参考范围。方法随机选取体检健康儿童80例,年龄1~16岁,男女各40例;同期选择典型HF表现的住院患儿70例;男32例,女38例;年龄1~16岁,患儿依原发病分为扩张型心肌病(DCM)组45例,其左室射血分数(LVEF)≤50%;室间隔缺损(VSD)组25例,LVEF为51%~78%。抽取静脉血以酶联免疫法(ELISA)测定血清NT-proBNP水平。均用超声心动图测定LVEF,用改良Ross评分评定HF临床程度。结果正常儿童血清NT-proBNP水平为75.8~429.2 fmol/mL(223.05±76.60)fmol/mL],血清NT-proBNP水平与年龄无关,女童略高于男童,但无显著性差异。HF患儿NT-proBNP水平为224.0~5330.8 fmol/mL(中位数1353.3 fmol/mL),第10百分位和第90百分位分别为341.63 fmol/mL、2794.07 fmol/mL,显著高于正常儿童(Z=-10.16 P<0.001)。DCM组血清NT-proBNP水平与LVEF呈负相关(r=-0.546)。HF患儿血清NT-proB-NP水平与临床心功能评分呈正相关(r=0.81)。NT-proBNP水平为351.46 fmol/mL时,诊断HF的敏感性为90.0%,特异性92.5%,ROC曲线下面积0.981(95%可信区间0.965~0.998 P<0.05)。正常小儿血清NT-proBNP水平为(223.1±76.6)fmol/mL,HF患儿血清NT-proBNP显著增高。结论血清NT-proBNP升高与HF严重程度呈正相关,选取NT-proBNP<332.7 fmol/mL为正常范围对HF诊断的敏感性和特异性较好,是小儿HF一个较好特异性生化指标。

Changes of N - Terminal Pro - Brain Natriuretic Peptide in Normal Children and Children with Congestive Heart Failure

Objective To determine the normal ranges of N-terminal pro-brain natriuretic peptide(NT-proBNP) in normal children and children with symptoms of heart failure(HF),and to study their clinical implications.Methods Concentrations of serum NT-proBNP were determined in 80 normal children and 70 children with clinical symptoms of HF.Venous blood was taken in each subject,and plasma NT-proBNP was determined by ELISA method.Eighty normal children included 40 boys and 40 girls.Their ages ranged from 1 to 16 years old.Seventy children with HF were divided into two groups.The first group(n=45,21 males,24 females) included children with symptoms of HF caused by dilated cardiomyopathy(DCM).Their ages ranged from 1 to 16 years,and they had a left ventricular ejection fraction(LVEF) of less than 50%.The second group(n=25,11 male,14 female) consisted of children with symptoms of HF due to ventricular septal defect(VSD).Their ages ranged from 1 to 16 years,and they had an LVEF of 51%-78%.The serum NT-pro BNP levels were determined by ELISA method and LVEF was measured by echocardiography and clinical symptom score of heart failure was defined by using Ross Score.Results Serum concentration of NT-proBNP was 223.05 fmol/mL in normal children from 1 to 16 years old.NT-proBNP levels did not show a significant age-related or sex-related differences.In children with HF,the plasma NT-proBNP levels were significantly elevated(mean:1353.3 fmol/mL) compared to normal children(t=8.964 P<0.05).NT-proBNP levels showed a negative correlation with the election fraction(r=-0.546 P<0.05) and a positive correlation with the clinical heart failure score(r=0.81 P<0.05).The ability of NT-proBNP to detect HF was assessed by using receiver operation characteristic curve(ROC) analysis.The area under the curve(AUC) for the ROC curve for identify HF was 0.981(95% CI 0.965 to 0.998,P<0.001).NT-pro BNP value of 351.46 fmol/mL had a sensitivity of 90.0 % and a specificity of 92.5% for detecting HF.Conclusions Plasma concentration of NT-proBNP was 223.05 fmol/mL in normal children.Plasma NT-proBNP levels increased significantly and reflected the severity of symptoms of heart failure and the impairment of cardiac function in children with HF.NT-proBNP may be a good indicator for the differential diagnosis of a broad spectrum of heart failure.