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目的探讨氮端B型利钠肽原(NT-pro BNP)在早产儿血流动力学显著的动脉导管未闭(hs PDA)中的诊断价值。方法选取我院新生儿重症监护病房收治的生后6 h内入院的胎龄28~33周早产儿,根据生后第3天的心脏彩超结果和临床症状分为hs PDA组和对照组。分别检测并比较两组生后第1、3天的血NT-pro BNP水平。应用受试者操作特性(ROC)曲线确定NT-pro BNP诊断hs PDA的临界值。结果共纳入46例早产儿,hs PDA组17例,对照组29例。生后第1天,hs PDA组和对照组NT-pro BNP水平差异无统计学意义[(1 980.9±674.5)pmol/L比(1 558.9±713.9)pmol/L,P>0.05]。生后第3天,hs PDA组NT-pro BNP水平明显高于对照组[(5 697.6±2 113.2)pmol/L比(1 486.9±710.1)pmol/L,P<0.05],差异有统计学意义。诊断hs PDA的ROC曲线下面积为0.948(95%CI 0.889~1.000,P<0.05),以1 850 pmol/L为临界值的灵敏度为100%,特异度为69%;最适临界值为2 150 pmol/L,灵敏度88%,特异度79%。结论生后第3天血NT-pro BNP水平有可能成为诊断早产儿hs PDA的良好指标。
Objective To investigate the diagnostic value of NT-proBNP in the diagnosis of preoperative hemodynamically significant patent ductus arteriosus (hs PDA). Methods Preterm infants of 28-33 gestational weeks hospitalized within 6 h postnatal neonatal intensive care unit admitted to our hospital were divided into hs PDA group and control group according to the results of cardiac ultrasonography and clinical symptoms on the third day after birth. The blood levels of NT-pro BNP on the first and third day after birth were detected and compared. The receiver operating characteristic (ROC) curve was used to determine the cutoff value of NT-pro BNP in the diagnosis of hs PDA. Results A total of 46 preterm infants were included, hs PDA group 17 cases and control group 29 cases. There was no significant difference in NT-pro BNP levels between hs PDA group and control group on the first day after birth [(1 980.9 ± 674.5) pmol / L (1 558.9 ± 713.9) pmol / L, P> 0.05]. On the third day after birth, NT-pro BNP level in hs PDA group was significantly higher than that in control group [(6969.6 ± 2 113.2) pmol / L vs (486.9 ± 710.1) pmol / L, P <0.05] significance. The area under the ROC curve of diagnosed hs PDA was 0.948 (95% CI 0.889-1.000, P <0.05). The sensitivity and specificity of 1 850 pmol / L were 100% and 69% respectively. The optimal cutoff value was 2 150 pmol / L, 88% sensitivity and 79% specificity. Conclusion The level of blood NT-pro BNP on the third day after birth may be a good indicator for the diagnosis of hs PDA in preterm infants.