氨基末端腦鈉肽前體對嬰兒期左向右分流型先天性心臟病心功能評估的臨床應(yīng)用價(jià)值
發(fā)布時(shí)間：2018-11-29 13:36
【摘要】：目的通過探討嬰兒期左向右分流型先天性心臟病(Congenital Heart Disease,CHD)患兒合并心力衰竭(Heart Failure,HF)時(shí)血漿氨基末端腦鈉肽前體(N-Terminal pro-Brain Natriuretic Peptide,NT-pro BNP)水平的變化情況,結(jié)合此類患兒合并HF時(shí)臨床心功能的的評估,分析血漿NT-pro BNP與改良Ross評分之間的相關(guān)性,并繪制受試者工作特征(Receiver Operating Characteristic,ROC)曲線,尋找嬰兒期左向右分流型CHD合并HF時(shí)的快速檢測手段,找出各心功能分級的HF患兒血漿NT-Pro BNP的診斷截?cái)嘀?量化HF分級,為嬰兒期左向右分流型CHD合并HF時(shí),提供更為客觀、簡便、實(shí)用的HF診斷標(biāo)準(zhǔn)。方法研究組為2015年1月-2016年6月安徽醫(yī)科大學(xué)兒科臨床學(xué)院心內(nèi)科收治的54例經(jīng)超聲心動圖確診的左向右分流型CHD患兒,其中包括房間隔缺損(Atrial Septal Defect,ASD)、室間隔缺損(Ventricular Septal Defect,VSD)、動脈導(dǎo)管未閉(Patent Ductus Arteriosus,PDA)�；純耗挲g為1月~1歲,平均年齡144±93天,其中男32例,女22例。對照組為經(jīng)超聲心動圖排除的無CHD,也無HF癥狀及腎功能正常的普通呼吸道感染患兒,共12例,其中男8例,女4例,年齡1月~1歲,平均年齡212±127天。研究組患兒根據(jù)改良Ross評分法將研究組進(jìn)行HF分級,其中無HF者13例,輕度HF者15例,中度HF者13例,重度HF者13例。所有研究組及對照組患兒在入院后抽取外周靜脈血,采用美國(羅氏)cobas h232快速心力衰竭診斷儀及同公司相應(yīng)的羅氏CARDIAC測試條進(jìn)行檢測。檢驗(yàn)結(jié)果8~12分鐘即可測出。結(jié)果CHD患兒的血漿NT-pro BNP水平與改良Ross評分成正相關(guān),隨改良Ross評分的增大而升高(r=0.85,P0.05)。與對照組相比,左向右分流型CHD患兒血漿NT-pro BNP水平明顯增高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),血漿NT-pro BNP在不同HF分級之間存在明顯差異(F=59.68,P0.05),不同程度HF患兒治療前后血漿NT-pro BNP存在明顯差異(P0.05)。通過繪制ROC曲線,得出左向右分流型CHD患兒合并HF時(shí),心功能不全時(shí)的血漿NT-pro BNP診斷截?cái)嘀禐?86.50pg/m L,診斷輕度HF的截?cái)嘀禐?35.50pg/m L,診斷中度HF的截?cái)嘀禐?680.5pg/m L,診斷重度HF的截?cái)嘀禐?863.00pg/m L。結(jié)論血漿NT-pro BNP可敏感地反映HF的嚴(yán)重程度,與改良Ross評分成正相關(guān)。通過研究得出NT-pro BNP286.50pg/m L時(shí),可作為判斷嬰兒期左向右分流型CHD患兒心功能不全的診斷截?cái)嘀?診斷輕度HF的截?cái)嘀禐?35.5pg/m L,診斷中度HF患兒的截?cái)嘀禐?680.5pg/m L,重度HF患兒截?cái)嘀禐?863pg/m L,不同心功能分組間治療前后有明顯差異,可作為此類患兒合并HF時(shí),評估治療效果的重要監(jiān)測手段。
[Abstract]:Objective to investigate the changes of plasma amino-terminal brain natriuretic peptide (N-Terminal pro-Brain Natriuretic Peptide,NT-pro BNP) levels in infants with left to right shunt congenital heart disease (Congenital Heart Disease,CHD) complicated with heart failure (Heart Failure,HF). The relationship between plasma NT-pro BNP and modified Ross score was analyzed by evaluating the clinical cardiac function of these children with HF, and the operating characteristic (Receiver Operating Characteristic,ROC curve was plotted. To find out the rapid detection method of left to right shunt type CHD combined with HF in infancy, to find out the diagnostic truncation value of plasma NT-Pro BNP in children with HF with different cardiac function grades, and to quantify the HF grade, which is when left to right shunt type CHD is combined with HF in infancy. To provide more objective, simple and practical diagnostic criteria for HF. Methods from January 2015 to June 2016, 54 patients with left to right shunt CHD, including atrial septal defect (Atrial Septal Defect,ASD), were treated in Department of Cardiology, Department of Pediatrics, Anhui Medical University. Ventricular septal defect (Ventricular Septal Defect,VSD), patent ductus arteriosus (Patent Ductus Arteriosus,PDA). The average age was 144 鹵93 days, including 32 males and 22 females. The control group consisted of 12 children with normal renal function, including 8 males and 4 females, aged from one month to one year, with an average age of 212 鹵127days. According to the modified Ross scoring method, the patients in the study group were graded with HF, including 13 cases without HF, 15 cases with mild HF, 13 cases with moderate HF and 13 cases with severe HF. The peripheral venous blood was taken from all the children in the study group and the control group after admission. The cobas H232 rapid heart failure diagnostic instrument and the corresponding Roche CARDIAC test strip were used to detect the results. The test results can be measured in 812 minutes. Results there was a positive correlation between the plasma NT-pro BNP level and the modified Ross score in children with CHD, which increased with the increase of the modified Ross score (P 0.05). Compared with the control group, the level of plasma NT-pro BNP in patients with left to right shunt type CHD was significantly increased (P0.05), and plasma NT-pro BNP was significantly different among different HF grades (F59.68%, P0.05). There was significant difference in plasma NT-pro BNP before and after treatment in children with HF of different degree (P0.05). By drawing ROC curve, the diagnostic truncation value of plasma NT-pro BNP in patients with left to right shunt type CHD combined with HF was 286.50pg/m L, and that of mild HF was 635.50pg/m L. In the diagnosis of moderate HF, the truncation value was 1680.5pg/m L, and the truncation value of severe HF was 3863.00pg/m L. Conclusion Plasma NT-pro BNP can sensitively reflect the severity of HF and has a positive correlation with the modified Ross score. The results show that NT-pro BNP286.50pg/m L can be used as the diagnostic truncation value of left to right shunt type CHD in infancy, and the truncation value of mild HF is 635.5pg/m L. The truncation value of moderate HF and severe HF was 1680.5pg/m L and 3863pg/m L, respectively. There were significant differences between different heart function groups before and after treatment, which could be used as an important monitoring method for evaluating the therapeutic effect of these children with HF.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.4
本文編號：2365135
[Abstract]:Objective to investigate the changes of plasma amino-terminal brain natriuretic peptide (N-Terminal pro-Brain Natriuretic Peptide,NT-pro BNP) levels in infants with left to right shunt congenital heart disease (Congenital Heart Disease,CHD) complicated with heart failure (Heart Failure,HF). The relationship between plasma NT-pro BNP and modified Ross score was analyzed by evaluating the clinical cardiac function of these children with HF, and the operating characteristic (Receiver Operating Characteristic,ROC curve was plotted. To find out the rapid detection method of left to right shunt type CHD combined with HF in infancy, to find out the diagnostic truncation value of plasma NT-Pro BNP in children with HF with different cardiac function grades, and to quantify the HF grade, which is when left to right shunt type CHD is combined with HF in infancy. To provide more objective, simple and practical diagnostic criteria for HF. Methods from January 2015 to June 2016, 54 patients with left to right shunt CHD, including atrial septal defect (Atrial Septal Defect,ASD), were treated in Department of Cardiology, Department of Pediatrics, Anhui Medical University. Ventricular septal defect (Ventricular Septal Defect,VSD), patent ductus arteriosus (Patent Ductus Arteriosus,PDA). The average age was 144 鹵93 days, including 32 males and 22 females. The control group consisted of 12 children with normal renal function, including 8 males and 4 females, aged from one month to one year, with an average age of 212 鹵127days. According to the modified Ross scoring method, the patients in the study group were graded with HF, including 13 cases without HF, 15 cases with mild HF, 13 cases with moderate HF and 13 cases with severe HF. The peripheral venous blood was taken from all the children in the study group and the control group after admission. The cobas H232 rapid heart failure diagnostic instrument and the corresponding Roche CARDIAC test strip were used to detect the results. The test results can be measured in 812 minutes. Results there was a positive correlation between the plasma NT-pro BNP level and the modified Ross score in children with CHD, which increased with the increase of the modified Ross score (P 0.05). Compared with the control group, the level of plasma NT-pro BNP in patients with left to right shunt type CHD was significantly increased (P0.05), and plasma NT-pro BNP was significantly different among different HF grades (F59.68%, P0.05). There was significant difference in plasma NT-pro BNP before and after treatment in children with HF of different degree (P0.05). By drawing ROC curve, the diagnostic truncation value of plasma NT-pro BNP in patients with left to right shunt type CHD combined with HF was 286.50pg/m L, and that of mild HF was 635.50pg/m L. In the diagnosis of moderate HF, the truncation value was 1680.5pg/m L, and the truncation value of severe HF was 3863.00pg/m L. Conclusion Plasma NT-pro BNP can sensitively reflect the severity of HF and has a positive correlation with the modified Ross score. The results show that NT-pro BNP286.50pg/m L can be used as the diagnostic truncation value of left to right shunt type CHD in infancy, and the truncation value of mild HF is 635.5pg/m L. The truncation value of moderate HF and severe HF was 1680.5pg/m L and 3863pg/m L, respectively. There were significant differences between different heart function groups before and after treatment, which could be used as an important monitoring method for evaluating the therapeutic effect of these children with HF.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.4
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