[氨基末端脑钠肽前体作为早产儿症状性动脉导管未闭预测标志物的价值]

[Value of amino-terminal pro-brain natriuretic peptide as a predictive marker of symptomatic patent ductus arteriosus in preterm infants].

作者信息

Lu Kai-Shan, Guo Xiao-Ling, Lv Jun-Feng, Huang Shao-Li, Yang Chun-Hui, Zou Zhi-Hui, Chen Zhi-Jun, Lai Chun-Hua, Yang Bing-Yan

机构信息

Department of Pediatrics, Third Clinical Medical College of Southern Medical University, Guangzhou 510630, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2015 Nov;17(11):1160-4.

PMID:26575871

Abstract

OBJECTIVE

To study the value of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting symptomatic patent ductus arteriosus (sPDA) in preterm infants.

METHODS

Preterm infants born at a gestational age (GA) of ≤ 32 weeks and diagnosed with patent ductus arteriosus (PDA) by echocardiography within 48 hours after birth between June 2014 and April 2015 were selected as subjects. Their clinical manifestations were observed, and serum NT-proBNP levels were measured and echocardiography was performed at 3 and 5 days after birth. The infants were divided into sPDA group and asymptomatic PDA (asPDA) group based on their clinical manifestations and the results of echocardiography. The correlations between serum NT-proBNP level and echocardiographic indices were analyzed. Serum NT-proBNP levels were compared between the two groups. The receiver operator characteristic (ROC) curve was applied to determine the sensitivity and specificity of serum NT-proBNP in the prediction of sPDA.

RESULTS

A total of 69 preterm infants were enrolled in this study, with 13 infants in the sPDA group and 56 infants in the asPDA group. Serum NT-proBNP level was positively correlated with the diameter of the arterial duct (r=0.856; P<0.05)and the ratio of left atrial diameter to aortic root diameter (LA/AO) (r=0.713; P<0.05). At 3 and 5 days after birth, the serum NT-proBNP levels in the sPDA group were significantly higher than those in the asPDA group (P<0.05). The area under the ROC curve (AUC) for the prediction of sPDA by NT-proBNP levels at 3 days after birth was 0.949 (95% CI: 0.892-1.000; P<0.001), with a cut-off value of 27 035 pg/mL (sensitivity: 92.3%; specificity: 94.6%); the AUC for the prediction of sPDA by NT-proBNP levels at 5 days after birth was 0.924 (95% CI: 0.848-1.000; P<0.001), with a cut-off value of 6 411 pg/mL (sensitivity: 92.3%; specificity: 92.9%).

CONCLUSIONS

NT-proBNP may be a quantitative index for shunt volume. The measurement of serum NT-proBNP levels on 3 and 5 days after birth may be useful to predict sPDA in preterm infants.

摘要

目的

探讨氨基末端脑钠肽前体（NT-proBNP）在预测早产儿症状性动脉导管未闭（sPDA）中的价值。

方法

选取2014年6月至2015年4月出生胎龄（GA）≤32周、出生后48小时内经超声心动图诊断为动脉导管未闭（PDA）的早产儿作为研究对象。观察其临床表现，于出生后3天和5天测定血清NT-proBNP水平并进行超声心动图检查。根据临床表现及超声心动图结果将患儿分为sPDA组和无症状PDA（asPDA）组。分析血清NT-proBNP水平与超声心动图指标的相关性。比较两组血清NT-proBNP水平。应用受试者工作特征（ROC）曲线确定血清NT-proBNP预测sPDA的敏感度和特异度。

结果

本研究共纳入69例早产儿，其中sPDA组13例，asPDA组56例。血清NT-proBNP水平与动脉导管内径（r=0.856；P<0.05）及左房内径与主动脉根部内径比值（LA/AO）（r=0.713；P<0.05）呈正相关。出生后3天和5天，sPDA组血清NT-proBNP水平显著高于asPDA组（P<0.05）。出生后3天NT-proBNP水平预测sPDA的ROC曲线下面积（AUC）为0.949（95%CI：0.892-1.000；P<0.001），截断值为27 035 pg/mL（敏感度：92.3%；特异度：94.6%）；出生后5天NT-proBNP水平预测sPDA的AUC为0.924（95%CI：0.848-1.000；P<0.001），截断值为6 411 pg/mL（敏感度：92.3%；特异度：92.9%）。