Yang Mei, Xuan Aili, Zhu Guoji
Department of Pediatrics, First Affiliated Hospital of Bengbu Medical University, Anhui, People's Republic of China.
Department of Infectious Diseases, Children's Hospital, Soochow University, Jiangsu, People's Republic of China.
J Multidiscip Healthc. 2025 Jun 26;18:3709-3716. doi: 10.2147/JMDH.S527700. eCollection 2025.
To evaluate the diagnostic performance of combined N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) testing for myocardial injury in children with Mycoplasma pneumoniae pneumonia (MPP).
This retrospective study included 103 pediatric patients with MPP complicated by myocardial injury admitted between December 2021 and December 2023. Patients were stratified by New York Heart Association (NYHA) functional class (I-IV). Demographic and clinical characteristics, biomarker levels, and diagnostic accuracy were analyzed. ROC curves were used to assess diagnostic performance of single and combined biomarkers.
No significant differences were observed in age or gender across NYHA classes. However, BMI Z-scores declined significantly with worsening class (P = 0.013), while heart rate, systolic blood pressure, fever duration, respiratory rate, and hospital stay increased progressively (all P < 0.01), indicating disease severity. Serum NT-proBNP and cTnI levels rose in parallel with advancing NYHA class (P < 0.001 between all adjacent groups). A strong positive correlation was found between NT-proBNP and cTnI (r = 0.617, P < 0.001). Combined biomarker testing demonstrated superior diagnostic accuracy (AUC = 0.914), outperforming NT-proBNP (AUC = 0.877) and cTnI alone (AUC = 0.739). The combination improved sensitivity (94.15%) and specificity (95.19%), reducing false negatives and enhancing risk stratification. Notably, 80% of NYHA class III-IV cases were correctly reclassified into the high-risk group, with a net reclassification improvement (NRI) of +34.2% (P = 0.002).
Combined NT-proBNP and cTnI testing provides robust diagnostic efficacy for myocardial injury in pediatric MPP. This dual-biomarker strategy enables earlier identification of high-risk patients and supports more precise clinical management.
评估联合检测N末端脑钠肽前体（NT-proBNP）和心肌肌钙蛋白I（cTnI）对支原体肺炎（MPP）患儿心肌损伤的诊断效能。
这项回顾性研究纳入了2021年12月至2023年12月期间收治的103例合并心肌损伤的MPP患儿。根据纽约心脏协会（NYHA）心功能分级（I-IV级）对患者进行分层。分析人口统计学和临床特征、生物标志物水平及诊断准确性。采用ROC曲线评估单一生物标志物和联合生物标志物的诊断效能。
NYHA各心功能分级间在年龄和性别上未观察到显著差异。然而，BMI Z评分随分级恶化显著下降（P = 0.013），而心率、收缩压、发热持续时间、呼吸频率和住院时间逐渐增加（均P < 0.01），提示疾病严重程度。血清NT-proBNP和cTnI水平随NYHA分级升高而平行升高（所有相邻组间P < 0.001）。NT-proBNP与cTnI之间存在强正相关（r = 0.617，P < 0.001）。联合生物标志物检测显示出更高的诊断准确性（AUC = 0.914），优于单独的NT-proBNP（AUC = 0.877）和cTnI（AUC = 0.739）。联合检测提高了敏感性（94.15%）和特异性（95.19%），减少了假阴性并增强了风险分层。值得注意的是，80%的NYHA III-IV级病例被正确重新分类到高危组，净重新分类改善（NRI）为+34.2%（P = 0.002）。
联合检测NT-proBNP和cTnI对MPP患儿心肌损伤具有强大的诊断效能。这种双生物标志物策略能够更早地识别高危患者，并支持更精确的临床管理。
