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目的评估N端脑钠肽原(NT-proBNP)对儿童肺炎合并心力衰竭(HF)的诊断价值。方法采用竞争性酶免疫法(EIA)测定血浆NT-proBNP浓度,同时测定CK-MB、LDH1和肌钙I(CTnI)的浓度。将肺炎患儿分成HF组和非HF组,HF组测左室射血分数(LVEF)。结果年龄介于2周至14岁的对照组血浆NT-proBNP水平基本保持稳定,平均值为(346.25±73.52)fmol/ml,HF组血浆NT-proBNP、CK-MB、LDH1和CTnI浓度的平均值高于非HF组:(1568±1061)fmol/ml比(553±190)fmol/ml、(85.80±28.60)U/L比(42.30±27.10)U/L、(452.00±227.00)U/L比(133.00±93.4)U/L、(3.48±1.56)ng/ml比(1.53±0.95)ng/ml。ROC曲线下面积(AUC)为0.888。诊断界点定为790fmol/ml时,NT-proBNP用以诊断肺炎合并HF的灵敏度、特异度和准确度分别是83.3%、91.7%和87.9%,阳性及阴性似然比分别为10和0.182,阳性和阴性预测值分别是20.4%和99.5%。多元线性回归分析显示LDH1和CTnI对血浆NT-proBNP水平的影响具有统计学意义;HF组血浆NT?proBNP水平与LVEF呈负相关。结论NT-proBNP是肺炎合并HF比较可靠的诊断指标,其水平的高低也反映了肺炎合并HF的严重程度以及心肌损害的程度。
Objective To evaluate the diagnostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in children with pneumonia complicated with heart failure (HF). Methods Plasma NT-proBNP concentrations were measured by competitive enzyme immunoassay (EIA), and the concentrations of CK-MB, LDH1 and CTnI were measured simultaneously. Children with pneumonia were divided into HF group and non-HF group, HF group left ventricular ejection fraction (LVEF). Results The plasma levels of NT-proBNP remained stable in the control group between the ages of 2 weeks and 14 years with an average of (346.25 ± 73.52) fmol / ml. The mean levels of NT-proBNP, CK-MB, LDH1 and CTnI in the HF group (458.00 ± 227.00) U / L (42.30 ± 27.10) U / L (85.80 ± 28.60) U / L were higher than those in non-HF group (1568 ± 1061 fmol / ml vs 553 ± 190 fmol / (133.00 ± 93.4) U / L, (3.48 ± 1.56) ng / ml vs (1.53 ± 0.95) ng / ml respectively. The area under the ROC curve (AUC) was 0.888. The sensitivity, specificity and accuracy of NT-proBNP in the diagnosis of pneumonia complicated with HF were 83.3%, 91.7% and 87.9%, respectively, with positive and negative likelihood ratios of 10 and 0.182, respectively, at a diagnostic cutoff of 790 fmol / ml. The positive and negative predictive values were 20.4% and 99.5%, respectively. Multivariate linear regression analysis showed that the effects of LDH1 and CTnI on plasma NT-proBNP levels were statistically significant, while plasma NT-proBNP levels in HF group were negatively correlated with LVEF. Conclusion NT-proBNP is a more reliable diagnostic indicator of pneumonia complicated with HF. The level of NT-proBNP also reflects the severity of pneumonia with HF and the degree of myocardial damage.