Cui Qintao, Liu Xiaochen, Su Guobao, Zhou Chaoyuan, Wang Junhua
Cardiovascular Surgery, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
Transl Pediatr. 2021 Oct;10(10):2573-2578. doi: 10.21037/tp-21-450.
To analyze the change and clinical significance of cortisol, B-type brain natriuretic peptide (BNP), and prostacyclin-2 (PGE-2) levels in premature infants with patent ductus arteriosus (PDA).
A total of 67 cases of premature infants admitted to our hospital from January 2018 to April 2020 were included, all of whom developed PDA (PDA group). According to the presence or absence of symptoms, they were divided into the symptomatic group (28 cases) and the asymptomatic group (39 cases). In addition, 62 premature infants without PDA who were born in our hospital during the same period were selected as the control group. The expression levels of cortisol, BNP, and PGE-2 in infants in different groups and between infants with symptoms and without symptoms were analyzed, along with the risk factors leading to PDA in preterm infants. The value of cortisol, BNP, and PGE-2 in the diagnosis of PDA in premature infants was also analyzed.
Compared with the control group, cortisol in the PDA group was significantly decreased (P<0.05), while the levels of BNP and PGE-2 were significantly increased (P<0.05). The cortisol level in the asymptomatic group was significantly higher than that in the symptomatic group, while the levels of BNP and PGE-2 were opposite, and the differences were statistically significant (P<0.05). Logistic regression analysis showed that birth weight <1,200 g, decreased cortisol, increased BNP, and increased PGE-2 were independent risk factors leading to PDA in preterm infants, and the differences were statistically significant (P<0.05). Receiver operating characteristic (ROC) curve showed that the sensitivity and specificity of cortisol+BNP+PGE-2 in the diagnosis of PDA in premature infants were 75.60% and 73.10%, respectively. The area under the curve (AUC) value was 0.759 (95% CI: 0.6110.859), which was significantly higher than the AUC values of the 3 tests alone (P<0.05).
The expression of cortisol decreased in premature infants with PDA, while the levels of BNP and PGE-2 significantly increased. Dynamic detection of the changes in these levels can provide an important reference for the early diagnosis of PDA and for the assessment of disease progression.
分析动脉导管未闭（PDA）早产儿皮质醇、B型脑钠肽（BNP）和前列环素-2（PGE-2）水平的变化及临床意义。
纳入2018年1月至2020年4月我院收治的67例早产儿，均发生PDA（PDA组）。根据有无症状分为有症状组（28例）和无症状组（39例）。另外，选取同期我院出生的62例无PDA的早产儿作为对照组。分析不同组婴儿及有症状和无症状婴儿之间皮质醇、BNP和PGE-2的表达水平，以及导致早产儿PDA的危险因素。还分析了皮质醇、BNP和PGE-2在早产儿PDA诊断中的价值。
与对照组相比，PDA组皮质醇显著降低（P<0.05），而BNP和PGE-2水平显著升高（P<0.05）。无症状组皮质醇水平显著高于有症状组，而BNP和PGE-2水平则相反，差异有统计学意义（P<0.05）。Logistic回归分析显示，出生体重<1200g、皮质醇降低、BNP升高和PGE-2升高是导致早产儿PDA的独立危险因素，差异有统计学意义（P<0.05）。受试者工作特征（ROC）曲线显示，皮质醇+BNP+PGE-2诊断早产儿PDA的敏感性和特异性分别为75.60%和73.10%。曲线下面积（AUC）值为0.759（95%CI：0.611~0.859），显著高于单项检测的AUC值（P<0.05）。
PDA早产儿皮质醇表达降低，而BNP和PGE-2水平显著升高。动态检测这些水平的变化可为PDA的早期诊断及病情进展评估提供重要参考。
