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目的探讨脑钠肽(BNP)在新生儿持续肺动脉高压(PPHN)诊断和治疗中的临床应用价值,明确BNP是否可以作为判别PPHN的生化定量指标。方法采用前瞻性对照研究,对54例发绀患儿及时行心脏彩色超声Doppler检查,结合临床鉴别出PPHN组29例、non-PPHN组25例,以同期住院无发绀患儿12例作为对照组。应用免疫荧光分析测定66例患儿血清BNP水平,比较各组患儿间BNP水平差异,应用SPSS 13.0统计软件描绘ROC曲线,评价该方法的价值及寻找判断PPHN的最佳临界值。结果 PPHN组新生儿BNP水平[(1 937.40±1 392.36)ng.L-1]显著高于non-PPHN组新生儿[(537.00±731.49)ng.L-1]和对照组[(50.72±36.50)ng.L-1](F=19.42,P<0.001),而non-PPHN和对照组BNP水平比较无统计学意义(P>0.05);ROC曲线下面积为0.903,95%可信区间0.818~0.988;判别PPHN的最佳BNP水平为807 ng.L-1,以此为标准,判别PPHN的灵敏度为0.828,特异度为0.880。结论 PPHN新生儿血清BNP水平明显升高,而BNP可作为一种动态观察指标,在判别PPHN的发生及指导合理治疗、判断预后中有重要临床意义。
Objective To investigate the clinical value of brain natriuretic peptide (BNP) in the diagnosis and treatment of neonatal persistent pulmonary hypertension (PPHN) and to determine whether BNP can be used as a biochemical quantitative indicator of PPHN. Methods A prospective and controlled study was conducted in 54 cyanotic children with Doppler echocardiography. 29 cases of PPHN group and 25 cases of non-PPHN group were identified clinically. Twelve children with cyanosis without hospitalization were selected as control group. Serum BNP levels were measured in 66 children by immunofluorescence analysis. The differences of BNP levels between the two groups were compared. The ROC curve was drawn by using SPSS 13.0 statistical software to evaluate the value of this method and find the best cut-off value for judging PPHN. Results The neonatal BNP level in PPHN group [(1 937.40 ± 1 392.36) ng.L-1] was significantly higher than that in non-PPHN group [(537.00 ± 731.49) ng.L-1] and [50.72 ± 36.50 ) ng.L-1] (F = 19.42, P <0.001), but there was no significant difference between non-PPHN and control group (P> 0.05). The area under ROC curve was 0.903, 95% confidence interval 0.818 ~ 0.988. The optimal BNP level of PPHN was 807 ng.L-1. As a standard, the sensitivity and specificity of PPHN were 0.828 and 0.880, respectively. Conclusions The serum level of BNP in neonates with PPHN is obviously increased, but BNP can be used as a kind of dynamic observation index. It has important clinical significance in discriminating the occurrence of PPHN and guiding rational treatment.