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目的探讨心力衰竭(HF)婴儿血浆脑利钠肽(BNP)水平变化与HF严重程度的关系,及其对婴儿HF诊断、心功能分级和疗效监测的临床意义。方法随机选取2006年10月-2008年9月在本院儿科住院的HF婴儿30例为研究对象,并根据Ross分级标准将其分成轻、中、重度3组。在HF纠正前后收集HF婴儿血浆,检测BNP水平。随机选取本院体检中心健康婴儿30例为健康对照组。健康对照组和HF组婴儿血浆BNP水平测定采用化学发光微粒子免疫分析法;采用M型超声心动图测量HF组婴儿的左心室射血分数(LVEF),并分析血浆BNP水平与LVEF的相关性。结果HF婴儿血浆BNP水平[(629.17±508.53)×10-6ng.L-1]显著高于健康对照组[(65.13±31.98)×10-6ng.L-1](t=4.884,P<0.05)。HF程度越重,血浆BNP水平升高越显著,血浆BNP水平与LVEF呈负相关(r=-0.508,P<0.05),与心功能分级呈正相关(r=0.527,P<0.01)。HF纠正后血浆BNP水平[(105.02±57.81)×10-6ng.L-1]显著低于HF纠正前[(629.17±508.53)×10-6ng.L-1](t=5.609,P<0.001)。结论BNP水平检测对HF婴儿诊断、心功能分级、疗效监测方面具有临床意义。
Objective To investigate the relationship between plasma brain natriuretic peptide (BNP) levels and severity of HF in infants with heart failure (HF) and its clinical significance in the diagnosis of infantile HF, the classification of cardiac function and the curative effect. Methods Thirty HF infants hospitalized in our pediatric department from October 2006 to September 2008 were randomly selected and divided into three groups according to Ross grading criteria: mild, moderate and severe. HF infant plasma was collected before and after HF correction, and BNP levels were measured. Thirty healthy infants randomly selected from our physical examination center were selected as healthy control group. Plasma BNP levels were measured by chemiluminescence microparticle immunoassay in healthy controls and HF infants. Left ventricular ejection fraction (LVEF) in infants in HF group was measured by M-mode echocardiography. Correlation between plasma BNP levels and LVEF was analyzed. Results The level of plasma BNP in HF infants was significantly higher than that in healthy controls [(629.17 ± 508.53) × 10-6 ng.L-1] (65.13 ± 31.98 × 10-6 ng.L-1) (t = 4.884, P <0.05 ). The more severe HF was, the more significant the plasma BNP level was. The plasma BNP level was negatively correlated with LVEF (r = -0.508, P <0.05), and positively correlated with the grade of cardiac function (r = 0.527, P <0.01). The plasma BNP levels after HF correction were significantly lower than those before HF correction (629.17 ± 508.53 × 10-6 ng.L-1) (t = 5.609, P <0.001, respectively; [(105.02 ± 57.81) × 10-6 ng.L- ). Conclusion The detection of BNP level has clinical significance in the diagnosis of HF, the grading of cardiac function and the monitoring of therapeutic effect.