Bagnoli F, Rossetti A, Casucci M, Mori A
Department of Pediatrics, Obstetrics and Reproduction Medicine, Neonatal Intensive Care, University of Siena, Italy.
Minerva Pediatr. 2010 Jun;62(3 Suppl 1):67-70.
NT-proBNP is a reliable index in case of cardiac diseases.
To evaluate the diagnostic usefulness of NT-proBNP as index of the closure of patent ductus arteriosus (PDA) in ELBW.
Considered 73 ELBW (mGA 26+3 weeks; mBW 789 g) with echocardiographical diagnosis of PDA. The closure of the duct was spontaneous in 22%, pharmacological in 49.3% and by surgical ligation in 28.7%. Plasma NT-proBNP levels were measured on day 3 in 35 preterm infants; in 20 of them concentrations of the peptide were assayed on day 3 and on closure of the duct.
On day 3 the median of NT-proBNP levels was 13718 pg/ml (range 1918-70000). Peptide concentrations did not differ between pharmacological treatment and surgical ligation (respectively 13718 and 12342 pg/ml; p = 0.33). Concentrations of NT-proBNP were significantly lower on the closure of the duct (p < 0.0001) compared to concentrations on day 3 (median 12666 at day 3 versus 2443.5 pg/ml at closure), with a decrease of 80.71%.
ELBW showed high variability of NT-proBNP concentrations both on day 3 and on closure of PDA. Although NT-proBNP high levels were indicative of the presence of hsPDA, due to the extreme heterogeneity of the values it was not possible to determine an absolute cut-off concentration of NT-proBNP below which closure of the duct occurred, while a decrease of NT-proBNP > or =80% was a reliable index of PDA closure.
N末端B型利钠肽原（NT-proBNP）是心脏病情况下的可靠指标。
评估NT-proBNP作为极低出生体重儿（ELBW）动脉导管未闭（PDA）闭合指标的诊断价值。
纳入73例经超声心动图诊断为PDA的ELBW（平均胎龄26+3周；平均出生体重789g）。导管自发闭合的占22%，药物治疗闭合的占49.3%，手术结扎闭合的占28.7%。对35例早产儿在出生第3天测定血浆NT-proBNP水平；其中20例在出生第3天和导管闭合时测定该肽的浓度。
出生第3天，NT-proBNP水平中位数为13718pg/ml（范围1918 - 70000）。药物治疗组和手术结扎组的肽浓度无差异（分别为13718和12342pg/ml；p = 0.33）。与出生第3天的浓度相比，导管闭合时NT-proBNP浓度显著降低（p < 0.0001）（出生第3天中位数为12666，闭合时为2443.5pg/ml），下降了80.71%。
ELBW在出生第3天和PDA闭合时NT-proBNP浓度存在高度变异性。虽然NT-proBNP高水平提示存在高风险PDA，但由于数值的极端异质性，无法确定一个绝对的NT-proBNP截止浓度，低于该浓度导管会发生闭合，而NT-proBNP下降≥80%是PDA闭合的可靠指标。
