Dong Xiang-yu, Hui Ying-chun, Shen Yang
Department of Pediatrics, the Second Hospital of Lanzhou University, Lanzhou 730000, China.
Zhonghua Er Ke Za Zhi. 2009 Jun;47(6):462-5.
Neonatal sepsis can cause multiple organ dysfunction syndrome, especially including myocardial injury and heart failure. In this study, the authors observed the changes and the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide in myocardial injury of neonatal sepsis at the different stages to search for the early diagnostic index of myocardial injury and heart failure in patients with neonatal septicemia.
The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were determined in 96 newborns with neonatal septicemia according to the diagnosis and treatment program of neonatal septicemia in 2003. The 96 cases were divided into myocardial injury group and non-myocardial injury group. Every newborn was tested for the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide with enzyme-linked immunosorbent assay (ELISA) on the second day, fifth day and tenth day of septicemia and in the different gestational age infants. Meanwhile, the results were compared to creatine kinase isoenzyme and troponin I.
The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly different between myocardial injury group and non-myocardial injury group at the fifth day (P<0.05), especially the levels of plasma N-terminal pro-B-type natriuretic peptide were significantly elevated at the early stage (on the second day) between the two groups (P<0.05). On the fifth day, the values of plasma N-terminal pro-B-type natriuretic peptide were (315.5 +/- 69.7) pmol/L in myocardial injury group, but the value of non-myocardial injury group was (179.3 +/- 27.5) pmol/L. On the fifth day, the results of plasma brain natriuretic peptide, N-terminal pro-B-type natriuretic peptide and troponin I were significantly different and had statistical significance between the myocardial injury group and non-myocardial injury group (P<0.05), while the results of creatine kinase isoenzyme had no statistically significant difference (P>0.05). The values of plasma brain natriuretic peptide were respectively (215.5 +/- 69.6) pmol/L and (119.3 +/- 37.4) pmol/L, While N-terminal pro-B-type natriuretic peptide were (315.5 +/- 69.7) pmol/L and (179.3 +/- 27.5) pmol/L in the two groups. The value of troponin I was (1.57 +/- 0.39) microg/L in the myocardial injury group and that in the non-myocardial injury group was (0.55 +/- 0.2) microg/L. The values of creatine kinase isoenzyme were (33.3 +/- 10.1) u/L in the myocardial injury group, but that of non-myocardial injury group was (17.4 +/- 8.5) u/L. In the different gestational age infants, the values of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide of premature infants were the highest in the three groups. The values of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were (159.5 +/- 39.6) pmol/L and (238.5 +/- 49.7) pmol/L in premature infants.
The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide evidently increased in myocardial injury of neonatal sepsis, especially in premature infants. The increase of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide may be helpful in early diagnosis of the myocardial injury of neonatal sepsis associated with cTnI. N-terminal pro-B-type natriuretic peptide may become a useful index to diagnose the myocardial injury and should be widely used in the neonatal intensive care unit.
新生儿败血症可导致多器官功能障碍综合征，尤其包括心肌损伤和心力衰竭。在本研究中，作者观察了新生儿败血症不同阶段心肌损伤时血浆脑钠肽和N末端B型利钠肽原的变化及水平，以寻找新生儿败血症患者心肌损伤和心力衰竭的早期诊断指标。
按照2003年新生儿败血症的诊疗方案，测定96例新生儿败血症患儿血浆脑钠肽和N末端B型利钠肽原水平。将96例患儿分为心肌损伤组和非心肌损伤组。在败血症第2天、第5天和第10天以及不同胎龄婴儿中，采用酶联免疫吸附测定法（ELISA）检测每例新生儿血浆脑钠肽和N末端B型利钠肽原水平。同时，将结果与肌酸激酶同工酶和肌钙蛋白I进行比较。
心肌损伤组和非心肌损伤组在第5天血浆脑钠肽和N末端B型利钠肽原水平有显著差异（P<0.05），尤其是两组在早期（第2天）血浆N末端B型利钠肽原水平显著升高（P<0.05）。第5天，心肌损伤组血浆N末端B型利钠肽原值为（315.5±69.7）pmol/L，而非心肌损伤组为（179.3±27.5）pmol/L。第5天，心肌损伤组和非心肌损伤组血浆脑钠肽、N末端B型利钠肽原和肌钙蛋白I结果有显著差异且具有统计学意义（P<0.05），而肌酸激酶同工酶结果无统计学差异（P>0.05）。两组血浆脑钠肽值分别为（215.5±69.6）pmol/L和（119.3±37.4）pmol/L，N末端B型利钠肽原分别为（315.5±69.7）pmol/L和（179.3±27.5）pmol/L。心肌损伤组肌钙蛋白I值为（1.57±0.39）μg/L，非心肌损伤组为（0.55±0.2）μg/L。心肌损伤组肌酸激酶同工酶值为（33.3±10.1）U/L，非心肌损伤组为（17.4±8.5）U/L。在不同胎龄婴儿中，早产儿血浆脑钠肽和N末端B型利钠肽原值在三组中最高。早产儿血浆脑钠肽和N末端B型利钠肽原值分别为（159.5±39.6）pmol/L和（238.5±49.7）pmol/L。
新生儿败血症心肌损伤时血浆脑钠肽和N末端B型利钠肽原水平明显升高，尤其是早产儿。血浆脑钠肽和N末端B型利钠肽原的升高可能有助于早期诊断与肌钙蛋白I相关的新生儿败血症心肌损伤。N末端B型利钠肽原可能成为诊断心肌损伤的有用指标，应在新生儿重症监护病房广泛应用。
