【血清氮端脑钠肽及脑钠肽在新生儿败血症合并心肌损伤时的临床意义】心肌肌钙蛋白小于0.01
[摘要] 目的 探讨脑钠肽（BNP）及氮端脑钠肽（NT- proBNP）在新生儿败血症心肌损伤诊断中的价值。 方法 选择37例新生儿败血症合并心功能异常患儿作为病例组，15例健康新生儿作为对照组参与本研究，采用ROSS新生儿心功能分级将患儿分为心功能Ⅰ、Ⅱ和Ⅲ级；采用心脏超声检测患儿左室射血分数（LVEF）；检测患儿血浆BNP及NT-proBNP水平，并在不同心功能分级患儿以及正常新生儿之间进行比较。 结果 病例组血浆BNP及NT-proBNP水平较对照组显著升高，差异具有统计学意义（P ＜ 0.05）；随着患儿心功能评级的上升，血浆BNP及NT-proBNP水平水平不断显著升高，LVEF不断显著降低，差异均具有统计学意义（均P ＜ 0.05）；在心功能Ⅰ级患儿，血浆NT- proBNP的升高率显著高于BNP升高率（P ＜ 0.05）。 结论 血浆BNP及NT-proBNP水平可作为新生儿败血症心肌损伤诊断的良好辅助指标；对于早期心肌损伤的诊断，NT-proBNP优于BNP。
[关键词] 新生儿败血症；脑钠肽；氮端脑钠肽；心肌损伤
[中图分类号] R722.131 [文献标识码] A [文章编号] 1673-7210（2012）08（b）-0089-03
Clinical significance on detection of serum NT-proBNP and BNP in diagnosis of cardiac injury in neonatal sepsis
GU Chengxiang
Department of Clinical Laboratory, the People′s Hospital of Sangzhi County in Zhangjiajie City, Hu′nan Province, Sangzhi 427100, China
[Abstract] Objective To explore the value of detection of BNP and NT- proBNP in neonatal sepsis. Methods 37 cases of neonatus with neonatal sepsis and abnormal cardiac function were selected as case group and 15 healthy neonates as control group were selected. ROSS classification was applied to put patients into classⅠ, Ⅱ, Ⅲ; LVEF was tested by cardiac ultrasound; levels of BNP and NT-proBNP among class Ⅰ, Ⅱ, Ⅲ and control group were detected and compared. Results Increased levels of BNP and NT-proBNP were found significantly in case group than in control group (P ＜ 0.05); along with upgrade of cardiac function classification and decrease of LVEF, increased levels of BNP and NT-proBNP were found significantly (P ＜ 0.05); in cardiac function class I, increase rate of NT-proBNP was found significantly higher than that of BNP (P ＜ 0.05). Conclusion Detection of BNP and NT-pro BNP could be utilized as auxiliary indexes in diagnosis of cardiac injury in neonatal sepsis; detection of NT-proBNP is more valuable than BNP in diagnosis of early stage cardiac injury in neonatal sepsis.
[Key words] Neonatal sepsis; BNP; NT-proBNP; Cardiac injury
新生儿败血症（neonatal sepsis）是新生儿科常见病，指因全身细菌感染引起的综合征，细菌通常进入血液循环大量繁殖并释放毒素。该病的发生率占活产婴儿的1%～10%，占极低体重儿的15%～20%，在发展中国家的死亡率为5%左右，在发展中国家可达到10%以上[1]。新生儿败血症进展过程中，可能引起全身炎症反应综合征（SIRS）甚至多器官功能衰竭综合征（MODS），其中心脏的损伤最为常见[2]。本研究采用血清脑钠肽（BNP）以及氮端脑钠肽（NT-proBNP）检测辅助诊断新生儿败血症患儿心脏损伤情况，现报道如下：
1 资料与方法
1.1 一般资料
选择2010年10月～2012年2月于我院新生儿ICU病房（NICU）住院治疗的新生儿败血症合并心功能异常患儿37例作为研究对象，设为病例组，新生儿败血症之诊断均参照《新生儿败血症诊疗方案》[3]中关于新生儿败血症的诊断标准，心功能则按照ROSS分级标准均为Ⅰ、Ⅱ、Ⅲ级，其中，男21例，女16例；胎龄2～29 d，平均（17.64±2.11）d；体重2 200～4 300 g，平均（3 254.10±245.21）g；原发病中新生儿脐炎14例，新生儿肺炎16例，新生儿肠炎4例，新生儿脓疱疹3例。经过心脏超声检查发现患儿伴发卵圆孔未闭、动脉导管未闭等先天性心脏病者不纳入本次研究。另选择新生儿科足月健康新生儿15例作为对照组，其中，男8例，女7例；平均胎龄（16.83±2.08）d；平均体重（3 430.62±273.55）g。两组在胎龄、性别构成及平均体重等方面差异无统计学意义（P ＜ 0.05）。