N端前脑钠肽作为法洛四联症手术矫正患儿再次手术的预测指标。

N-terminal pro-brain natriuretic peptide as a predictor of reoperation in children with surgically corrected tetralogy of fallot.

作者信息

Hirono Keiichi, Sekine Michikazu, Shiba Noriko, Hayashi Shirou, Nakaoka Hideyuki, Ibuki Keijiro, Saito Kazuyoshi, Watanabe Kazuhiro, Ozawa Sayaka, Higuma Tomonori, Yoshimura Naoki, Kitajima Isao, Ichida Fukiko

机构信息

Department of Pediatrics, Graduate School of Medicine, University of Toyama.

出版信息

Circ J. 2014;78(3):693-700. doi: 10.1253/circj.cj-13-1048. Epub 2013 Dec 11.

DOI:10.1253/circj.cj-13-1048

PMID:24334564

Abstract

BACKGROUND

Most patients with surgically corrected tetralogy of Fallot (TOF) are faced with multiple residua and sequelae such as pulmonary regurgitation (PR), resulting in reoperation for pulmonary valve replacement (PVR). Plasma brain natriuretic peptide (BNP) level and serum N-terminal pro-BNP (NT-pro-BNP) level are useful as diagnostic objective markers of chronic heart failure (CHF). The aim of the study was to examine whether these markers have predictive ability for reoperation in children with surgically corrected TOF.

METHODS AND RESULTS

Fifty-eight patients (38 male, 20 female) aged 1-18 years (median, 7 years) were enrolled. Serum NT-pro-BNP in TOF patients was significantly higher than in age-matched hospital controls without CHF (359.5±449.7pg/ml vs. 86.1±45.1pg/ml, respectively; P<0.0001). BNP and NT-pro-BNP had a better correlation with CHF index, RVEDP, and LVEDV in TOF groups. Children with surgically corrected TOF who had indication for PVR had higher BNP and NT-pro-BNP and more severe PR than those without indication for PVR. On multivariate logistic regression analysis, NT-pro-BNP was the strongest predictor for reoperation in patients with surgically corrected TOF. Area under the curve of NT-pro-BNP for reoperation was 0.950 (P<0.001) with a sensitivity of 88.9% and specificity of 91.8%.

CONCLUSIONS

NT-pro-BNP is a good biomarker for monitoring CHF, and is a good predictor of PVR in children with surgically repaired TOF.

摘要

背景

大多数接受手术矫正的法洛四联症（TOF）患者面临多种残留病变和后遗症，如肺动脉反流（PR），这导致需要再次手术进行肺动脉瓣置换（PVR）。血浆脑钠肽（BNP）水平和血清N末端脑钠肽前体（NT-pro-BNP）水平可作为慢性心力衰竭（CHF）的诊断客观标志物。本研究的目的是探讨这些标志物对接受手术矫正的TOF患儿再次手术是否具有预测能力。

方法与结果

纳入58例年龄在1至18岁（中位数为7岁）的患者（38例男性，20例女性）。TOF患者的血清NT-pro-BNP显著高于年龄匹配的无CHF的医院对照患者（分别为359.5±449.7pg/ml和86.1±45.1pg/ml；P<0.0001）。在TOF组中，BNP和NT-pro-BNP与CHF指数、右心室舒张末期压力（RVEDP）和左心室舒张末期容积（LVEDV）具有更好的相关性。有PVR指征的接受手术矫正的TOF患儿比无PVR指征的患儿具有更高的BNP和NT-pro-BNP水平以及更严重的PR。多因素逻辑回归分析显示，NT-pro-BNP是接受手术矫正的TOF患者再次手术的最强预测因子。NT-pro-BNP预测再次手术的曲线下面积为0.950（P<0.001），敏感性为88.9%，特异性为91.8%。