| 陈凯权,徐艳,吴铭,等.氨基末端 B型尿钠肽前体在早产儿动脉导管未闭诊治中应用[J].安徽医药,2021,25(12):2459-2462. |
| 氨基末端 B型尿钠肽前体在早产儿动脉导管未闭诊治中应用 |
| Application of NT-proBNP in diagnosis and treatment of patent ductus arteriosus in premature infants |
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| DOI：10.3969/j.issn.1009-6469.2021.12.029 |
| 中文关键词: 动脉导管未闭 氨基末端 B型尿钠肽前体 脑钠肽 对乙酰氨基酚 婴儿，早产 |
| 英文关键词: Ductus arteriosus, patent N. Terminal pro B. Type natriuretic peptide (NT-proBNP) B. Type natriuretic peptide Acetaminophen Infant, premature |
| 基金项目:2019年度蚌埠医学院自然科学重点项目( BYKY2019247ZD) |
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| 中文摘要: |
| 目的研究氨基末端 B型尿钠肽前体( N. Terminal pro B. Type natriuretic peptide，NT-proBNP)在动脉导管未闭( patent ductus arteriosus，PDA)诊断及治疗中的意义，探寻预测血流动力学显著动脉导管未闭( haemodynamically significant PDA，hsP. DA)的 NT-proBNP阈值。方法选取 2019年 1月至 2020年 7月蚌埠医学院第三附属医院收治的 115例早产儿作为研究对象。依据出生后 3d心脏彩超检查分为无 PDA组( nPDA组)(n=46)、血流动力学显著异常动脉导管未闭组( hsPDA组)(n=38)、无症状性 PDA组( asymptomatic PDA，asPDA组)(n=31)。 hsPDA组予口服对乙酰氨基酚治疗，复查心脏彩超分为 PDA关闭组及未关闭组。监测并比较 nPDA、asPDA、hsPDA各组生后 3 d NT-proBNP值、关闭组与未关闭组治疗前与治疗后的 NT-proBNP值；使用受试者工作特征( receiver operating characteristic，ROC)曲线下面积预测诊断 hsPDA的最佳切点。结果 nPDA、asPDA、hsP. DA三组生后 3 d NT-proBNP分别为 1 859.50(1 508.00，2 373.50)ng/L、3 213.00(2 987.00，3 906.00)ng/L、9 830.00(6 251.00，1 2961.50)ng/L，asPDA组高于 nPDA组， hsPDA明显高于 asPDA组(均 P<0.05)。 hsPDA早产儿关闭组与未关闭组治疗前 NT-proBNP分别为 7 521.00(3 813.00，9 635.00)ng/L、1 2093.00(10 086.00，15 651.00)ng/L，未关闭组明显高于关闭组( P<0.05)；组治疗后分别为 2 039.00(1 423.00，4 089.00)ng/L、7 365.00(5 609.00，8 697.00)ng/L，关闭组明显低于未关闭组( P<0.05)。生两后 3d，预测 hsPDA的 NT-proBNP值为 9 875.50时，诊断 hsPDA的灵敏度为 0.842，特异度为 0.895。结论 NT-proBNP有助于临床诊断 PDA、预测干预时机，并为 hsPDA疗效评估提供帮助。 |
| 英文摘要: |
| Objective To study the significance of N. Terminal pro B. Type natriuretic peptide (NT-proBNP) in the diagnosis and treatment of patent ductus arteriosus (PDA), and to explore the NT-proBNP threshold of hemodynamically significant patent ductus arte. riosus (hsPDA).Methods A total of 115 preterm infants hospitalized in NICU of the Third Affiliated Hospital of Bengbu Medical Col.lege from January 2019 to July 2020 were selected as the research objects. According to the echocardiogram results 3 days after birth,the objects were assigned into non-PDA group (nPDA group, n=46), hemodynamically significant patent ductus arteriosus group (hsP. DA group, n=38) and asymptomatic patent ductus arteriosus group (asPDA group, n=31). After oral acetaminophen treatment, hsPDAgroup was assigned into PDA closed group (closed group) and PDA unclosed group (non-closed group) according to the echocardiogram results. The NT-proBNP values of nPDA, asPDA and hsPDA groups 3 days after birth were monitored and compared. Similarly, the NT-proBNP values of the closed group and the non-closed group before and after treatment were recorded and compared. The area underthe receiver operating characteristic curve (ROC) was used to predict and diagnose the optimal tangent point of hsPDA.Results The levels of NT-proBNP were 1 859.50 (1 508.00,2 373.50) ng/L, 3 213.00 (2 987.00,3 906.00) ng/L, 9 830.00 (6 251.00,1 2961.50) ng/Lin nPDA, asPDA and hsPDA groups on the third day after birth, which was higher in asPDA group than in nPDA group, and higher inhsPDA group than in asPDA group (all P<0.05). The levels of NT-proBNP in hsPDA premature infants before treatment were 7 521.00 (3 813.00,9 635.00) ng/L and 12 093.00 (10 086.00,15 651.00) ng/L in the closed group and the non-closed group respectively, which was significantly higher in the non-closed groupthan in the closed group (P<0.05). After treatment, the levels of NT-proBNP in the twogroups were 2 039.00 (1 423.00,4 089.00) ng/L and 7 365.00 (5 609.00,8 697.00) ng/L, which was significantly lower in the closedgroup than in the non-closed group (P<0.05). On the third day after birth, NT-proBNP value which can be used to predict hsPDA was 9 875.50 ng/L, with sensitivity of 0.842 and specificity of 0.895.Conclusion NT-proBNP is helpful to carry out the clinical diagnosisand determine the intervention opportunity of PDA, which is also an optional method to predict the therapeutic efficacy of hsPDA. |
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