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目的:通过检测小儿先天性心脏病患儿行心脏手术前血浆生物学标志物氨基末端B型利钠肽前体(NT-proB-NP),绘制ROC曲线,分析其特异度和敏感度,探讨NT-proBNP慢性心力衰竭诊断指标截断点。方法:测定2010年9月～2012年9月佛山市顺德区妇幼保健院收治的100例小儿先天性心脏病术前患儿和100例健康儿童的血浆NT-proBNP实验室指标,以改良Ross评分为标准诊断的心力衰竭患儿为心力衰竭组,无心力衰竭的患儿为无心力衰竭组,健康儿童为对照组,通过绘制ROC曲线分析其特异度和敏感度,探讨NT-proBNP小儿先天性心脏病心力衰竭诊断指标截断点。其结果进行统计学分析比较。结果:100例小儿先天性心脏病患儿中32例NT-proBNP指标异常升高,心力衰竭组与无心力衰竭组、正常组3组血浆NT-proBNP比较及轻、中、重度心力衰竭3组血浆NT-proBNP比较差异均有统计学意义(P均<0.001)。NT-ProBNP与改良Ross标准的相关性比较差异有统计学意义(r=0.592,P<0.001)。NT-proBNP诊断心力衰竭的ROC曲线下面积为0.983(95%可信区间:0.965～0.996),按照ROC曲线选取的诊断截断点为≥547 ng/L,此数值可作为小儿先天性心脏病NT-proBNP心力衰竭诊断参考指标。结论:小儿先天性心脏病术前心力衰竭患儿血浆NT-proBNP心力衰竭诊断截断点为≥547 ng/L,其特异度和敏感度之和最高,此数值可作为小儿先天性心脏病术前NT-proBNP心力衰竭诊断参考指标。
OBJECTIVE: To determine the specificity and sensitivity of ROC curve by detecting the plasma concentration of amino-terminal pro-B-natriuretic peptide (NT-proB-NP) before cardiac surgery in children with congenital heart disease NT-proBNP diagnostic indicators of chronic heart failure cut-off point. Methods: The plasma NT-proBNP laboratory indexes of 100 children with congenital heart disease and 100 healthy children admitted to Shunde District Maternal and Child Health Hospital from September 2010 to September 2012 were measured to improve the Ross score The children with heart failure who were diagnosed as standard were heart failure group, heart failure patients without heart failure group and healthy children as control group. The specificity and sensitivity of ROC curve analysis were analyzed to explore the congenital Cardiac heart failure diagnostic indicators cut-off point. The results of statistical analysis and comparison. Results: Thirty-two cases of NT-proBNP were abnormally elevated in 100 children with congenital heart disease. The levels of plasma NT-proBNP in the heart failure group and the normal group were significantly lower than those in the normal group Plasma NT-proBNP were significantly different (P <0.001). The correlation between NT-ProBNP and modified Ross criteria was statistically significant (r = 0.592, P <0.001). The area under the ROC curve of NT-proBNP for diagnosis of heart failure was 0.983 (95% confidence interval: 0.965-0.996). The diagnostic cut-off point was ≥547 ng / L according to the ROC curve. This value could be used as a marker for congenital heart disease in children NT -proBNP heart failure diagnosis reference index. Conclusion: The cut-off point of plasma NT-proBNP heart failure in children with congenital heart disease preoperative heart failure is ≥547 ng / L, the highest specificity and sensitivity, the value can be used as a preoperative congenital heart disease in children with preoperative NT-proBNP heart failure diagnosis reference index.