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目的探讨脑钠肽(BNP)和C反应蛋白(CRP)在先天性心脏病(CCHD)合并心力衰竭(CHF)患儿外周血中的表达及临床意义。方法选择天津市儿童医院2014年5月-2015年5月期间收治的102例先天性心脏病患儿为对象,其中25例为单纯CCHD(纯CCHD组),54例合并CHF(CCHD+CHF组),23例合并CHF及肺炎(CCHD+CHF+肺炎组)。以同期健康儿童和肺炎患儿各30例为对照。使用ELISA检测各组外周血BNP、CRP水平,分析CCHD合并CHF患儿BNP、CRP的表达水平,及两者与左心室射血分数(LVEF)的关系。结果 CCHD+CHF组、CCHD+CHF+肺炎组的BNP、CRP水平均显著高于小儿肺炎组和健康对照组(P<0.05)。单纯CCHD组的BNP和CRP水平显著低于CCHD+CHF组和CCHD+CHF+肺炎组(P<0.05)。CCHD+CHF组的BNP、CRP水平显著高于健康对照组和小儿肺炎组(P<0.05)。在CCHD+CHF组中,重度亚组的BNP、CRP表达显著高于中度亚组,中度亚组合重度亚组显著高于轻度亚组(P<0.05)。BNP水平与CCHD+CHF组的LVEF呈负相关(P<0.05)。结论 BNP和CRP可用于CCHD合并CHF患儿的早期诊断。BNP与CCHD合并CHF病患的LVEF呈负相关关系,其可以作为心功能评估的独立因子。
Objective To investigate the expression and clinical significance of brain natriuretic peptide (BNP) and C-reactive protein (CRP) in peripheral blood of children with congenital heart disease (CCHD) and heart failure (CHF). Methods Totally 102 children with congenital heart disease admitted to Tianjin Children’s Hospital from May 2014 to May 2015 were enrolled. Among them, 25 were simple CCHD (pure CCHD group), 54 were complicated with CHF (CCHD + CHF group) ), 23 patients with CHF and pneumonia (CCHD + CHF + pneumonia group). In the same period, 30 healthy children and children with pneumonia were used as control. The levels of BNP and CRP in peripheral blood of each group were detected by ELISA. The expressions of BNP and CRP in children with CCHD complicated with CHF were analyzed, and their relationship with left ventricular ejection fraction (LVEF) was also analyzed. Results The levels of BNP and CRP in CCHD + CHF group and CCHD + CHF + pneumonia group were significantly higher than those in pediatric pneumonia group and healthy control group (P <0.05). BNP and CRP levels in CCHD + CCHD + CHF group and CCHD + CHF + pneumonia group were significantly lower than those in CCHD + CHF group (P <0.05). The levels of BNP and CRP in CCHD + CHF group were significantly higher than those in healthy control group and pediatric pneumonia group (P <0.05). In CCHD + CHF group, the expressions of BNP and CRP in severe subgroup were significantly higher than those in moderate subgroup, moderate subgroup was significantly higher than in mild subgroup (P <0.05). BNP level was negatively correlated with LVEF in CCHD + CHF group (P <0.05). Conclusion BNP and CRP can be used for the early diagnosis of CHF in children with CCHD and CHF. BNP was negatively correlated with LVEF in patients with CHF and CCHD, which could be an independent factor in the assessment of cardiac function.