Kalra Vaneet K, DeBari Vincent A, Zauk Adel, Kataria Preetika, Myridakis Dorothy, Kiblawi Fuad
Department of Internal Medicine, School of Health and Medical Sciences, Seton Hall University, 400 South Orange Ave, South Orange, NJ 07079, USA.
Ann Clin Lab Sci. 2011 Spring;41(2):131-7.
Patent ductus arteriosus (PDA) is highly prevalent in pre-term neonates (PTN) and has been recognized as a neonatal co-morbidity. The purpose of this study was to determine if levels of brain (or B-type) natriuretic peptide (BNP), a peptide secreted by ventricular myocytes in response to volume or pressure overload, correlate with the size of the PDA. In a prospective design, 52 PTN (no PDA: n=24; PDA: n=28) were studied after obtaining parental consent. Those with genetic anomalies and congenital heart disease, except for PDA and patent foramen ovale, were excluded. Echocardiographic estimates of the diameters of the PDA (or absence of PDA) were made concurrently with capillary blood collection for BNP assay. BNP levels in samples from PTN without PDA were 23.6 ng/L (median); 13.1 to 32.3 ng/L (IQR); initial samples (between days 3 and 7 of life) with small PDA (n=11), median 66.1 ng/L; 55.5 to 85.3 ng/L (IQR); with moderate PDA (n=6) median 284 ng/L; 204 to 622 ng/L (IQR); and with large PDA (n=11) 2410 ng/L median; 420 to 2770 ng/L (IQR). (p< 0.0001 for ANOVA; groupwise: p<0.05 for both no PDA vs. moderate and large PDA); Trend analysis suggested a strong association of BNP with size of PDA (p<0.001). Of 17 subjects with moderate to large PDA, pre and post-treatment (Ibuprofen; per standard protocol) data were obtained on 12 subjects. Pre-treatment BNP ranged from 111 to 5000 ng/L; post-treatment BNP decreased to 5.0 to 262 ng/L (p = 0.0005). Estimates of decision levels for treatment were made by examining dichotomized groups, i.e., no-to-small vs. moderate-to-large and using receiver-operator characteristic (ROC) curve analysis yielding a value of 123 ng/L. BNP may obviate repeated echocardiography as follow up after treatment, or to monitor future course of respiratory distress secondary to PDA in PTN.
动脉导管未闭（PDA）在早产儿（PTN）中非常普遍，并且已被认为是一种新生儿合并症。本研究的目的是确定脑（或B型）利钠肽（BNP）的水平是否与PDA的大小相关，BNP是心室肌细胞在容量或压力过载时分泌的一种肽。在一项前瞻性设计中，在获得家长同意后，对52例PTN（无PDA：n = 24；PDA：n = 28）进行了研究。排除患有遗传异常和先天性心脏病的患者，但PDA和卵圆孔未闭除外。在采集毛细血管血进行BNP检测的同时，用超声心动图估计PDA的直径（或无PDA）。无PDA的PTN样本中的BNP水平为23.6 ng/L（中位数）；13.1至32.3 ng/L（四分位间距）；小PDA（n = 11）的初始样本（出生后第3至7天之间），中位数为66.1 ng/L；55.5至85.3 ng/L（四分位间距）；中度PDA（n = 6）中位数为284 ng/L；204至622 ng/L（四分位间距）；大PDA（n = 11）中位数为2410 ng/L；420至2770 ng/L（四分位间距）。（方差分析p < 0.0001；组间比较：无PDA与中度和大PDA比较，p均< 0.05）；趋势分析表明BNP与PDA大小有很强的相关性（p < 0.001）。在17例中度至大PDA患者中，对12例患者进行了治疗前和治疗后（布洛芬；按照标准方案）的数据采集。治疗前BNP范围为111至5000 ng/L；治疗后BNP降至5.0至262 ng/L（p = 0.0005）。通过检查二分法分组，即无至小与中度至大，并使用受试者工作特征（ROC）曲线分析得出决策水平估计值为123 ng/L。BNP可能避免治疗后作为随访的重复超声心动图检查，或监测PTN中继发于PDA的呼吸窘迫的未来病程。
