Holmström H, Hall C, Stokke O, Lindberg H, Thaulow E
Barneklinikken, Rikshospitalet, Oslo.
Tidsskr Nor Laegeforen. 1999 Aug 20;119(19):2838-41.
Measurement of plasma levels of natriuretic peptides are now in clinical use in adult patients with heart failure. Experiences in adult medicine cannot be extended to paediatric cardiology due to important physiological differences between adults and children. The haemodynamic background of heart failure in children with congenital heart disease is diverse, and there is no relevant functional or echocardiographic grading system. The authors present results from published studies and summarizes the results of a research project concerning the clinical potential of N-terminal proatrial natriuretic peptide (Nt-proANP) in paediatric cardiology. Peptide levels in newborn children with or without disease are not fully clarified. In children above three months of age, an elevated Nt-proANP value strongly indicates haemodynamic imbalance. This may be important in the follow-up of children with congenital heart disease. A normal value does not exclude the presence of heart disease. A case report illustrates the clinical use of Nt-proANP, and peptide levels in different haemodynamic situations are discussed.
利钠肽血浆水平的检测目前已应用于成年心力衰竭患者的临床治疗中。由于成人与儿童在生理上存在重要差异，成人医学的经验不能直接推广到儿科心脏病学领域。先天性心脏病患儿心力衰竭的血流动力学背景各不相同，且不存在相关的功能或超声心动图分级系统。作者介绍了已发表研究的结果，并总结了一项关于N端前心钠素（Nt-proANP）在儿科心脏病学中临床应用潜力的研究项目的结果。患有或未患疾病的新生儿体内的肽水平尚未完全明确。在三个月以上的儿童中，Nt-proANP值升高强烈提示血流动力学失衡。这对于先天性心脏病患儿的随访可能具有重要意义。正常数值并不能排除心脏病的存在。一份病例报告说明了Nt-proANP的临床应用，并讨论了不同血流动力学情况下的肽水平。
