Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Heinrich Heine University, Düsseldorf, Germany.
Neonatology. 2012;101(4):260-6. doi: 10.1159/000334826. Epub 2012 Jan 4.
Hemodynamically significant patent ductus arteriosus (hsPDA) is the most common functional cardiovascular disease in preterm infants. The necessity to treat hsPDA can neither be derived solely from clinical nor from echocardiographic criteria.
The aim of this study was to establish non-invasive parameters which can differentiate hsPDA from non-hsPDA.
Urinary protein levels of NT-proBNP, NGAL, and H-FABP were measured and correlated with the necessity of therapy for PDA. In 37 neonates (<1,500 g), urinary protein concentrations were tested on days 0, 2, and 7 by ELISA methodology. Of 37 infants, 12 required therapeutic interventions according to current treatment standards.
Infants receiving an intervention for PDA showed significantly higher levels of pro-BNP, NGAL, and H-FABP at all time points except for NT-proBNP on day 0. Infants requiring a second or third course of ibuprofen had significantly higher levels of H-FABP and NGAL. In all samples, the concentration of the three proteins correlated positively with each other.
The present study shows that measurement of urinary proteins is a powerful and non-invasive method to quantify the effect of PDA on systemic perfusion in preterm infants. Furthermore, NGAL and H-FABP may be used to indicate the necessity of pharmacological or surgical treatment of PDA.
动脉导管未闭（hsPDA）是早产儿最常见的功能性心血管疾病。是否需要治疗 hsPDA 既不能仅根据临床标准，也不能仅根据超声心动图标准来判断。
本研究旨在建立可将 hsPDA 与非 hsPDA 区分开来的非侵入性参数。
通过酶联免疫吸附法（ELISA）在第 0、2 和 7 天测量 NT-proBNP、NGAL 和 H-FABP 的尿蛋白水平，并将其与 PDA 治疗的必要性相关联。在 37 名（<1500g）新生儿中，测试了 37 名婴儿的尿蛋白浓度。根据目前的治疗标准，有 12 名婴儿需要进行治疗干预。
接受 PDA 干预的婴儿在所有时间点的 pro-BNP、NGAL 和 H-FABP 水平均显著高于非 hsPDA 婴儿，但在第 0 天的 NT-proBNP 水平除外。需要第二或第三次布洛芬治疗的婴儿的 H-FABP 和 NGAL 水平显著升高。在所有样本中，这三种蛋白质的浓度彼此之间呈正相关。
本研究表明，测量尿蛋白是一种强大的非侵入性方法，可定量评估 PDA 对早产儿全身灌注的影响。此外，NGAL 和 H-FABP 可用于指示是否需要对 PDA 进行药物或手术治疗。
