Rossano Joseph W, Denfield Susan W, Kim Jeffrey J, Price Jack F, Jefferies John L, Decker Jamie A, Smith E O'Brian, Clunie Sarah K, Towbin Jeffrey A, Dreyer William J
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA.
J Heart Lung Transplant. 2008 Jun;27(6):649-54. doi: 10.1016/j.healun.2008.03.008. Epub 2008 Apr 24.
The utility of B-type natriuretic peptide (BNP) for detecting acute rejection (AR) is unclear. The purpose of our study was to evaluate BNP as a screening test for AR in pediatric heart transplant patients.
All endomyocardial biopsies (EMBs) with concurrent BNP levels from February 2004 through March 2007 at the study institution were reviewed and the association between BNP levels and acute rejection was assessed.
Eighty-six patients underwent a total of 560 EMBs. The median age at EMB was 10.5 years (interquartile range [IQR] 3.7 to 15.4 years). There were 59 episodes of AR, 32 (54%) occurring at <1 year post-transplant. BNP levels were higher in patients with AR, median 387 pg/ml (IQR 125 to 931 pg/ml), compared with those without AR, median 66 pg/ml (IQR 37 to 148 pg/ml) (p < 0.001). The receiver operating characteristic (ROC) curve for BNP demonstrated an area under the curve (AUC) of 0.82 (95% confidence interval [CI] 0.76 to 0.88) (p < 0.001). A BNP level of 100 pg/ml corresponded to a sensitivity of 0.85 (95% CI 0.73 to 0.92) and a negative predictive value (NPV) of 0.97 (95% CI 0.95 to 0.99) for detecting AR. The ROC curve for patients at >1 year post-transplant demonstrated an AUC of 0.86 (95% CI 0.80 to 0.93) (p < 0.001), and a BNP level of 100 pg/ml corresponded to a sensitivity of 0.96 (95% CI 0.79 to 0.99) and NPV of 0.994 (95% CI 0.962 to 0.999) for detecting AR.
BNP levels have a high sensitivity and NPV for evaluating AR in pediatric heart transplant patients. In patients >1 year post-transplant, a BNP level of <100 pg/ml correlates with a <1% chance of AR and may obviate the need for EMB in some cases.
B型利钠肽（BNP）用于检测急性排斥反应（AR）的效用尚不清楚。我们研究的目的是评估BNP作为小儿心脏移植患者AR筛查试验的价值。
回顾了2004年2月至2007年3月在研究机构进行的所有同时检测BNP水平的心肌内膜活检（EMB），并评估BNP水平与急性排斥反应之间的关联。
86例患者共进行了560次EMB。EMB时的中位年龄为10.5岁（四分位间距[IQR]为3.7至15.4岁）。有59次AR发作，其中32次（54%）发生在移植后<1年。与无AR的患者相比，AR患者的BNP水平更高，中位值为387 pg/ml（IQR为125至931 pg/ml），而无AR患者的中位值为66 pg/ml（IQR为37至148 pg/ml）（p<0.001）。BNP的受试者操作特征（ROC）曲线显示曲线下面积（AUC）为0.82（95%置信区间[CI]为0.76至0.88）（p<0.
