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目的探讨氨基末端脑钠素原(NT-proBNP)在小儿先天性心脏病(先天性心脏病)并肺动脉高压(肺高压)的诊断价值。方法2005年1月至2007年3月山东大学齐鲁儿童医院内科采用竞争性酶免疫法检测20例正常对照组小儿及65例先天性心脏病患儿血清NT-proBNP浓度。65例先天性心脏病患儿经用彩色多普勒超声心动图估测肺动脉压力,分为三组:无肺高压组20例、轻度肺高压组23例、中重度肺高压组22例。结果1、先天性心脏病无肺高压组较正常对照组NT-proBNP水平略有增高,但无明显统计学差异(P>0.05)。2、先天性心脏病并轻度肺高压组NT-proBNP水平明显高于先天性心脏病无肺高压组(P<0.001)。3、中重度肺高压组患儿NT-proBNP水平较轻度肺高压组明显增高(P<0.001)。4、以500 fmol/m l诊断轻度肺高压的敏感度为91%,特异度为90%,且经直线相关分析,显示NT-proBNP与肺高压高低呈正相关,r=0.80。结论血清NT-proBNP检测对先天性心脏病并肺高压具有敏感而特异的诊断价值,且可反映肺动脉压增高程度。
Objective To investigate the diagnostic value of NT-proBNP in children with congenital heart disease (congenital heart disease) and pulmonary hypertension (pulmonary hypertension). Methods From January 2005 to March 2007, Qilu Children’s Hospital of Shandong University used competitive enzyme immunoassay to detect NT-proBNP levels in 20 normal children and 65 children with congenital heart disease. 65 cases of congenital heart disease in children with color Doppler echocardiography to assess pulmonary artery pressure, divided into three groups: no pulmonary hypertension group of 20 cases, mild pulmonary hypertension group of 23 cases, 22 cases of moderate and severe pulmonary hypertension group. Results 1, NT-proBNP levels in patients with congenital heart disease without pulmonary hypertension were slightly higher than those in the control group, but no significant difference (P> 0.05). NT-proBNP levels in patients with congenital heart disease and mild pulmonary hypertension were significantly higher than those without pulmonary hypertension in patients with congenital heart disease (P <0.001). The level of NT-proBNP in moderate-severe pulmonary hypertension group was significantly higher than that in mild pulmonary hypertension group (P <0.001). 4. The sensitivity and specificity of 500 fmol / m l for the diagnosis of mild pulmonary hypertension were 91% and 90% respectively. The linear correlation analysis showed that NT-proBNP was positively correlated with pulmonary hypertension, r = 0.80. Conclusion Serum NT-proBNP test is sensitive and specific to pulmonary hypertension in patients with congenital heart disease and can reflect the increase of pulmonary arterial pressure.