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目的探讨氨基末端脑钠肽前体(NT-pro BNP)预测早产儿症状性动脉导管未闭(s PDA)的价值。方法选择2014年6月至2015年4月出生、胎龄≤32周、48 h内超声心动图确定存在动脉导管的早产儿为研究对象,监测其临床表现,于生后3 d及5 d检测血清NT-pro BNP水平并行超声心动图检查,根据患儿临床表现、超声心动图结果分为s PDA组及非症状性动脉导管未闭(as PDA)组,分析血清NT-pro BNP水平与超声指标的关系,比较两组间相同日龄血清NT-pro BNP水平,ROC曲线确定血清NT-pro BNP水平预测s PDA的敏感性、特异性。结果共69例早产儿纳入研究,其中s PDA组13例,as PDA组56例。血清NT-pro BNP水平与动脉导管管径、左房内径与主动脉根部内径比值(LA/AO)呈正相关关系(分别r=0.856、0.713,均P<0.05);生后3 d、5 d,s PDA组血清NT-pro BNP水平均高于as PDA组,差异有统计学意义(P<0.05)。生后3 d血清NT-pro BNP水平预测s PDA的ROC曲线下面积为0.949(95%CI:0.892~1.000,P<0.001),临界值为27 035 pg/m L,敏感度为92.3%,特异度为94.6%;生后5 d血清NT-pro BNP水平预测s PDA的ROC曲线下面积为0.924(95%CI:0.848~1.000,P<0.001),临界值为6 411 pg/m L,敏感度为92.3%,特异度为92.9%。结论 NT-pro BNP可能是动脉导管分流量的量化指标;生后3 d及5 d血清NT-pro BNP水平的检测均有助于早期预测s PDA。
Objective To investigate the value of NT-pro BNP in the prediction of symptomatic patent ductus arteriosus (PDA) in preterm infants. Methods Preterm infants with ductus arteriosus who were born from June 2014 to April 2015 with gestational age≤32 weeks and 48 hours were enrolled in this study. The clinical manifestations were monitored at 3 days and 5 days after birth Serum NT-pro BNP level by echocardiography, according to the clinical manifestations of children, echocardiography results were divided into s PDA group and non-symptomatic patent ductus arteriosus (as PDA) group, analysis of serum NT-pro BNP levels and ultrasound The correlation between NT-pro BNP level and serum NT-pro BNP level at the same age were compared between the two groups by ROC curve to predict the sensitivity and specificity of s PDA. Results A total of 69 preterm infants were included in the study, of which 13 were PDA group and 56 as PDA group. The serum NT-pro BNP levels were positively correlated with the diameter of catheter, diameter of left atrium and ratio of aortic root diameter (LA / AO) (r = 0.856,0.713, all P <0.05) , serum NT-pro BNP levels in s PDA group were higher than those in as PDA group, the difference was statistically significant (P <0.05). The predicted area under the ROC curve of sPAD was 0.949 (95% CI: 0.892-1.000, P <0.001) at 3 days after birth, with a critical value of 27 035 pg / m L and a sensitivity of 92.3% The specificity of NTD proBNP was 94.6%. The area under the ROC curve of serum NT-pro BNP at 5 d after birth was 0.924 (95% CI: 0.848-1.000, P <0.001) with a critical value of 6 411 pg / m L, Sensitivity was 92.3%, specificity was 92.9%. Conclusions NT-pro BNP may be a quantitative indicator of arterial shunt volume. The detection of serum NT-pro BNP levels at 3 d and 5 d after birth contributes to the early prediction of s PDA.