Wu Yu-rong, Chen Shu-bao, Huang Mei-rong, Zhang Yu-qi, Sun Kun, Chen Sun
Cardiology Department, Shanghai Children's Medical Center, Shanghai 200127, China.
Zhonghua Er Ke Za Zhi. 2005 Mar;43(3):161-4.
The value of plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) can reflect cardiac function and therefore can be used for diagnosing congestive heart failure (CHF) and evaluating cardiac function. There are few reports, however, on the value of BNP and NT-proBNP in pediatric cases of congenital heart defect. The aim of this study was to assess the value of plasma NT-proBNP in the diagnosis of CHF and evaluation of cardiac function in pediatric patients with ventricular septal defect (VSD).
Fifty-one patients with VSD aged from 2 months to 2 years old (mean 7.9 months) were enrolled. According to the modified Ross Score, the patients were divided into three groups, no CHF group (20 patients), mild CHF group (18 patients) and moderate to severe CHF group (13 patients). Fifteen age-matched normal children were used as controls. Plasma NT-proBNP was measured using enzyme immunoassay. All patients had complete echocardiographic study, including measurement of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic wall stress (LVSEWS), heart rate corrected mean velocity of circumferential fiber shortening (mVcFc), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and contractility index (Con). The correlation between plasma NT-proBNP level and modified Ross Score and echocardiographic cardiac functional indexes was determined. The sensitivity, specificity and ROC curve of plasma NT-proBNP for diagnosing CHF was studied.
Plasma NT-proBNP was positively correlated with modified Ross Score (r = 0.75, P < 0.01). Plasma NT-proBNP concentration in moderate to severe CHF group (2061 +/- 908) fmol/ml was significantly higher than that of mild CHF group (810 +/- 335) fmol/ml, and Plasma NT-proBNP concentration in mild CHF group was higher than that in no CHF group (309 +/- 68) fmol/ml. 97.14% of normal controls and subjects in no CHF group had their plasma NT-proBNP below 400 fmol/ml. 83.3% of children in mild CHF group had their plasma NT-proBNP between (400-1400) fmol/ml while in moderate and severe CHF group 84.6% of children had their plasma NT-proBNP beyond 1400 fmol/ml. Plasma NT-proBNP was also positively correlated with LVEDVI and LVSEWS. There was no correlation among mVcFc, LVEF, LVFS, Con and plasma NT-proBNP concentration. Using plasma NT-proBNP concentration > or = 400 fmol/ml as cut-point for diagnosing CHF, the sensitivity was 89.3%, the specificity was 91.2%, and the area under the ROC curve was 0.944.
Plasma NT-proBNP level could be used to assess cardiac function and diagnose CHF in pediatric patients with VSD.
血浆脑钠肽（BNP）和N末端脑钠肽原（NT-proBNP）的值可反映心功能，因此可用于诊断充血性心力衰竭（CHF）和评估心功能。然而，关于BNP和NT-proBNP在小儿先天性心脏病病例中的价值报道较少。本研究旨在评估血浆NT-proBNP在小儿室间隔缺损（VSD）患者CHF诊断及心功能评估中的价值。
纳入51例年龄在2个月至2岁（平均7.9个月）的VSD患者。根据改良Ross评分，将患者分为三组，无CHF组（20例）、轻度CHF组（18例）和中重度CHF组（13例）。选取15例年龄匹配的正常儿童作为对照。采用酶免疫法测定血浆NT-proBNP。所有患者均进行了完整的超声心动图检查，包括测量左心室舒张末期容积指数（LVEDVI）、左心室收缩末期壁应力（LVSEWS）、心率校正的平均圆周纤维缩短速度（mVcFc）、左心室射血分数（LVEF）、左心室缩短分数（LVFS）和收缩性指数（Con）。确定血浆NT-proBNP水平与改良Ross评分及超声心动图心功能指标之间的相关性。研究血浆NT-proBNP诊断CHF的敏感性、特异性及ROC曲线。
血浆NT-proBNP与改良Ross评分呈正相关（r = 0.75，P < 0.01）。中重度CHF组血浆NT-proBNP浓度（2061±908）fmol/ml显著高于轻度CHF组（810±335）fmol/ml，轻度CHF组血浆NT-proBNP浓度高于无CHF组（309±68）fmol/ml。97.14%的正常对照及无CHF组受试者血浆NT-proBNP低于400 fmol/ml。轻度CHF组83.3%的儿童血浆NT-proBNP在（400 - 1400）fmol/ml之间，而中重度CHF组84.6%的儿童血浆NT-proBNP超过1400 fmol/ml。血浆NT-proBNP也与LVEDVI和LVSEWS呈正相关。mVcFc、LVEF、LVFS、Con与血浆NT-proBNP浓度之间无相关性。以血浆NT-proBNP浓度≥400 fmol/ml作为诊断CHF的切点，敏感性为89.3%，特异性为91.2%，ROC曲线下面积为0.944。
血浆NT-proBNP水平可用于评估小儿VSD患者的心功能及诊断CHF。
