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目的探讨左向右分流型先天性心脏病(congenital heart disease,CHD)患儿合并心力衰竭时血浆氨基末端B型利钠肽前体(amino terminal B-type natriuretic peptide precursor,NT-pro BNP)变化及其在心功能评价中的价值,分析其与改良Ross评分之间的相关性,寻找小儿心力衰竭时快速检测手段。方法研究对象为1个月~1岁的婴儿,实验组为55例左向右分流型CHD患儿,按照改良Ross评分标准分为4组,治疗前后进行对照。另选12名无CHD及心力衰竭的患儿作为对照组。采用美国(罗氏)快速心力衰竭诊断仪测定患儿血浆NT-pro BNP水平,分析其变化意义,采用SPSS 17.0统计学软件进行统计分析,多组间比较用F检验,通过ROC曲线图,得到诊断截断值。结果 NT-pro BNP与改良Ross评分成正相关(r=0.859),CHD患儿NT-pro BNP水平明显高于对照组,差异有统计学意义(P<0.05),各心力衰竭分组之间差异存在统计学意义(P<0.05)。心力衰竭患儿治疗后,血浆NT-pro BNP明显下降,差异有统计学意义(P<0.001),NT-pro BNP诊断心功能不全的截断值为286.5 pg/ml(95%CI 0.571~0.955)。结论不同程度心力衰竭患儿NT-pro BNP之间存在明显差异,血浆NT-pro BNP可作为婴儿期左向右分流型CHD合并心力衰竭时心功能评估的一个客观指标。
Objective To investigate the changes of plasma N-terminal pro-brain natriuretic peptide precursor (NT-pro BNP) in children with congenital heart disease (CHD) with heart failure And its value in the evaluation of cardiac function, analysis of its correlation with modified Ross score, to find rapid detection of heart failure in children means. Methods The subjects were 1 month to 1 year old infants. The experimental group was 55 cases of CHD children with left-to-right shunt. The patients were divided into 4 groups according to modified Ross score, and were compared before and after treatment. Another 12 children without CHD and heart failure as control group. The level of plasma NT-pro BNP in children was detected by American Roche Fast Heart Failure Diagnostic Instrument. The significance of the changes was analyzed. SPSS 17.0 statistical software was used for statistical analysis. Multiple groups were compared by F test and ROC curve was used to diagnose Cut off value. Results There was a positive correlation between NT-pro BNP and modified Ross score (r = 0.859). The level of NT-pro BNP in children with CHD was significantly higher than that in control group (P <0.05) Statistical significance (P <0.05). After treatment of children with heart failure, plasma NT-pro BNP levels decreased significantly (P <0.001). The cut-off value of NT-pro BNP in diagnosing cardiac insufficiency was 286.5 pg / ml (95% CI 0.571-0.9595) . Conclusion There is a significant difference between NT-pro BNP in children with different degrees of heart failure. Plasma NT-pro BNP can be used as an objective index in the assessment of cardiac function in CHD patients with left-to-right shunt CHD.