An Jin-Dou, Zhang Yan-Ping, Zhou Jian-Hua
Department of Pediatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2006 Jun;8(3):201-4.
Some research has shown that B-type brain natriuretic peptide (BNF) is helpful in differentiating cardiac from pulmonary etiologies of dyspnea in adults. This study was designed to investigate whether BNP concentration could be similarly applied in children presenting with dyspnea.
Blood samples were collected from 65 children presenting with dyspnea, due to congestive heart failure (CHF, n=24), pneumonia (n=23) or pneumonia together with CHF (n=18). The samples from 15 healthy children were used as the controls. There were no significant differences in age among the four groups. Serum BNP levels were measured using ELISA.
Serum BNP levels in the CHF group (141.55 +/- 75.99 pg/mL) were significantly higher than those in the Pneumonia group (26.00 +/- 14.57 pg/mL; P < 0.01), and the Pneumonia together with CHF group (113.73 +/- 87.05 pg/mL; P < 0.05), as well as the Control group (19.31 +/- 10.30 pg/mL; P < 0.01). The patients with pneumonia together with CHF had significantly higher serum BNP levels than those of the Pneumonia and the Control groups (P < 0.01). There were no significant differences in BNP levels between the Pneumonia and the Control groups. The area under the receive operator characteristic (ROC) curve, which demonstrated the diagnostic utility of BNP in differentiating CHF from pneumonia, was 0.978 (P < 0.01). At a cut-off of 49 pg/mL, BNP had a sensitivity of 87.5% and a specificity of 95.8% for differentiating CHF from pneumonia. In the 18 patients who were diagnosed with pneumonia together with CHF, 11 had BNP levels above 49 pg/mL. The mean levels of BNP of the 11 patients were significantly higher than those of the patients with pneumonia (172.08 +/- 56.47 pg/mL vs 25.00 +/- 14.57 pg/mL; P < 0.01) but were significantly decreased after treatment (26.12 +/- 15.71 pg/mL; P < 0.01).
BNP level is of value in differentiating cardiac from pulmonary causes of dyspnea in children. BNP level is also helpful in assessing whether or not severe pneumonia couples with heart failure in children.
一些研究表明，B型脑钠肽（BNF）有助于区分成人呼吸困难的心脏病因与肺部病因。本研究旨在调查BNP浓度是否可同样应用于出现呼吸困难的儿童。
收集了65例因充血性心力衰竭（CHF，n = 24）、肺炎（n = 23）或肺炎合并CHF（n = 18）而出现呼吸困难的儿童的血样。来自15名健康儿童的样本用作对照。四组之间在年龄上无显著差异。使用酶联免疫吸附测定法（ELISA）测量血清BNP水平。
CHF组的血清BNP水平（141.55±75.99 pg/mL）显著高于肺炎组（26.00±14.57 pg/mL；P < 0.01）、肺炎合并CHF组（113.73±87.05 pg/mL；P < 0.05）以及对照组（19.31±10.30 pg/mL；P < 0.01）。肺炎合并CHF的患者血清BNP水平显著高于肺炎组和对照组（P < 0.01）。肺炎组和对照组之间的BNP水平无显著差异。接受者操作特征（ROC）曲线下面积显示了BNP在区分CHF与肺炎方面的诊断效用，为0.978（P < 0.01）。在区分CHF与肺炎时，以49 pg/mL为临界值，BNP的敏感性为87.5%，特异性为95.8%。在18例被诊断为肺炎合并CHF的患者中，11例的BNP水平高于49 pg/mL。这11例患者的BNP平均水平显著高于肺炎患者（172.08±56.47 pg/mL对25.00±14.57 pg/mL；P < 0.01），但治疗后显著降低（26.12±15.71 pg/mL；P < 0.01）。
BNP水平在区分儿童呼吸困难的心脏病因与肺部病因方面具有价值。BNP水平也有助于评估儿童严重肺炎是否合并心力衰竭。
