Khan S S, Sithisarn T, Bada H S, Vranicar M, Westgate P M, Hanna M
Division of Neonatology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, KY, USA.
Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, KY, USA.
J Perinatol. 2017 Dec;37(12):1319-1324. doi: 10.1038/jp.2017.139. Epub 2017 Sep 14.
Patent ductus arteriosus (PDA) is common in preterm infants and is associated with significant morbidities. B type natriuretic peptide (BNP) is synthesized in the ventricles secondary to volume overload and excreted as urinary N-terminal pro-brain natriuretic peptide (NT-proBNP).
We report an observational prospective study of 64 preterm infants with birth weight ⩽1000 g. Echocardiographic parameters were obtained from clinical echocardiograms performed in the first week of life. Urinary NT-proBNP/creatinine ratios (pg mg) were measured on the same day of the echocardiograms.
Infants with medium to large PDA (n=39) had significantly higher NT-proBNP/creatinine levels compared with infants with small PDA (n=10) (median (IQ range): 2333 (792-6166) vs 714 (271-1632) pg mg, P=0.01) and compared with infants with no PDA (n=15) (2333 (792-6166) vs 390 (134-1085) pg mg, P=0.0003). Urinary NT-proBNP/creatinine ratios were significantly lower post treatment if PDA closed (n=17), P=0.001 or if PDA became smaller after treatment (n=9), P=0.004. Urinary NT-proBNP/creatinine levels correlated with ductal diameter (P⩽0.0001), but not with LA/Ao ratio (P=0.69) or blood flow velocity through the ductus (P=0.06).
Our findings indicate that there is a positive correlation between ductal diameter and urinary NT-proBNP in preterm infants.
动脉导管未闭（PDA）在早产儿中很常见，且与严重疾病相关。B型利钠肽（BNP）在容量超负荷继发于心室时合成，并作为尿N末端脑利钠肽原（NT-proBNP）排出。
我们报告了一项对64例出生体重≤1000g的早产儿进行的观察性前瞻性研究。超声心动图参数取自出生后第一周进行的临床超声心动图检查。在超声心动图检查的同一天测量尿NT-proBNP/肌酐比值（pg/mg）。
中至大型PDA患儿（n=39）的NT-proBNP/肌酐水平显著高于小型PDA患儿（n=10）（中位数（四分位间距）：2333（792-6166） vs 714（271-1632）pg/mg，P=0.01），也高于无PDA患儿（n=15）（2333（792-6166） vs 390（134-1085）pg/mg，P=0.0003）。如果PDA闭合（n=17），治疗后尿NT-proBNP/肌酐比值显著降低，P=0.001；或者如果PDA在治疗后变小（n=9），P=0.004。尿NT-proBNP/肌酐水平与导管直径相关（P≤0.0001），但与左房/主动脉比值（P=0.69）或通过动脉导管的血流速度（P=0.06）无关。
我们的研究结果表明，早产儿的导管直径与尿NT-proBNP之间存在正相关。
