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目的研究青紫型先天性心脏病患儿血清氨基末端脑利钠肽前体(N-terminal proBNP,NT-proBNP)水平,探讨其临床意义。方法采集先天性心脏病患儿的血清,按照小儿心衰改良Ross标准分为无心衰的非青紫型组48例,青紫型无心衰组23例,青紫型轻度心衰组10例;对照组为同期门诊体检的正常儿童25例;酶联免疫法(ELISA)检测血清NT-proBNP;测经皮血氧饱和度(SaO2)、红细胞计数(RBC)、红细胞压积(HCT)、血红蛋白(Hb);采用单因素方差分析、LSD法及Pearson相关分析进行统计处理。结果 (1)与正常对照组(34.35±4.98)fmol/ml及非青紫型组(38.54±4.50)fmol/ml比较,青紫型无心衰组患儿血清NT-proBNP(55.87±7.96)fmol/ml分别增高62.6%,45.0%,差异有统计学意义(P<0.01);与青紫型无心衰组(55.87±7.96)fmol/ml比较,青紫型轻度心衰组血清NT-proBNP(91.83±17.01)fmol/ml增高64.6%,差异有统计学意义(P<0.01)。(2)不同类型非青紫型先心患儿、青紫型先心患儿间NT-proBNP、SaO2、RBC计数、HCT、Hb比较,均无明显差异(P<0.05)。(3)青紫型无心衰组患儿血清NT-proBNP与SaO2呈明显负相关(r=-0.63,P<0.01);而与RBC、HCT及Hb浓度无相关性(P<0.05)。结论青紫型先心病患儿血清NT-proBNP水平升高可能与心脏缺氧严重程度相关;其可以用于是否合并心衰的早期诊断及预测。
Objective To investigate the serum level of serum N-terminal proBNP (NT-proBNP) in children with cyanotic congenital heart disease and to explore its clinical significance. Methods The serum of children with congenital heart disease was collected and divided into non-purple group with no heart failure (48 cases), no cyanotic heart failure group (23 cases) and cyanotic mild heart failure group (10 cases) The control group consisted of 25 normal children undergoing outpatient examinations at the same period. Serum NT-proBNP was detected by enzyme-linked immunosorbent assay (ELISA); the levels of SaO2, RBC, HCT, (Hb). One-way ANOVA, LSD and Pearson correlation analysis were used for statistical analysis. Results Compared with normal control group (34.35 ± 4.98) fmol / ml and non-purple group (38.54 ± 4.50) fmol / ml, NT-proBNP was significantly higher in children with no heart failure (55.87 ± 7.96 fmol / ml respectively (P <0.01). Compared with the group without faint heart failure (55.87 ± 7.96) fmol / ml, the serum NT-proBNP (91.83 ± 17.01) fmol / ml increased 64.6%, the difference was statistically significant (P <0.01). (2) NT-proBNP, SaO2, RBC counts, HCT and Hb in children with different types of non-purple heart-shaped syndrome were not significantly different (P <0.05). (3) Serum NT-proBNP was negatively correlated with SaO2 (r = -0.63, P <0.01), but not with RBC, HCT and Hb (P <0.05). Conclusion Serum NT-proBNP levels in children with cyanosis may be related to the severity of cardiac hypoxia. It may be used for the early diagnosis and prediction of CHF.