新生儿窒息后心肌损伤中N末端脑钠肽前体的临床研究

A Clinical Study of the N-Terminal pro-Brain Natriuretic Peptide in Myocardial Injury after Neonatal Asphyxia.

作者信息

Zhu Rui, Nie Zhenhong

机构信息

Department of Pediatrics, Zhongnan Hospital of Wuhan University, Hubei 430071, China.

Department of Epidemiology, School of Public Health, Wuhan University, Hubei 430071, China.

出版信息

Pediatr Neonatol. 2016 Apr;57(2):133-9. doi: 10.1016/j.pedneo.2015.08.001. Epub 2015 Aug 20.

DOI:10.1016/j.pedneo.2015.08.001

PMID:26385820

Abstract

BACKGROUND

We aimed to study the changes of serum N-terminal pro-brain natriuretic to peptide (NT-proBNP) levels after asphyxia-induced myocardial injury in children and explore the relationship between serum NT-proBNP levels and neonatal asphyxia.

METHODS

One hundred and six cases of neonatal asphyxia were randomly selected for the study, including 46 severe cases with myocardial injury and 60 mild cases with no cardiac injury. Sixty-three healthy newborns were selected as the control group. The serum NT-proBNP level was detected using electrochemiluminescence. Creatine kinase MB (CK-MB) and serum sodium and calcium were measured simultaneously.

RESULTS

The serum NT-proBNP level in the myocardial injury group was significantly higher than that of the noncardiac injury and control groups (p < 0.01). Asphyxia serum NT-proBNP and cardiac enzymes were significantly correlated. The median value of neonatal NT-proBNP was 1491 pg/mL at postnatal Day 3 (P3) and 1077 pg/mL at postnatal Day 14 (P14). The cutoff value for children with myocardial injury was 3612.5 pg/mL; the area under the receiver operating characteristic curve was 0.80 (p < 0.001), with a sensitivity of 83.3%, a specificity of 80.5%, a positive predictive value of 82.8%, and a negative predictive value of 79.4%. After treatment, the serum NT-proBNP level in children with myocardial damage showed a significant decrease.

CONCLUSION

The serum NT-proBNP level can reflect myocardial injury in neonates with asphyxia and can guide its diagnosis.

摘要

背景

我们旨在研究儿童窒息所致心肌损伤后血清N末端脑钠肽前体（NT-proBNP）水平的变化，并探讨血清NT-proBNP水平与新生儿窒息之间的关系。

方法

随机选取106例新生儿窒息病例进行研究，其中46例为伴有心肌损伤的重症病例，60例为无心脏损伤的轻症病例。选取63例健康新生儿作为对照组。采用电化学发光法检测血清NT-proBNP水平。同时测定肌酸激酶同工酶MB（CK-MB）以及血清钠和钙。

结果

心肌损伤组血清NT-proBNP水平显著高于非心脏损伤组和对照组（p < 0.01）。窒息血清NT-proBNP与心肌酶显著相关。新生儿NT-proBNP在出生后第3天（P3）的中位数为1491 pg/mL，在出生后第14天（P14）为1077 pg/mL。心肌损伤患儿的截断值为3612.5 pg/mL；受试者工作特征曲线下面积为0.80（p < 0.001），灵敏度为83.3%，特异度为80.5%，阳性预测值为82.8%，阴性预测值为79.4%。治疗后，心肌损伤患儿的血清NT-proBNP水平显著下降。