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目的观察先天性心脏病(CHD)并心力衰竭(HF)患儿血浆氨基末端脑利钠肽前体(NT-proBNP)水平的变化,分析NT-proBNP与HF严重程度的关系及在心功能评估中的价值。方法选择本院2008年6月-2011年6月住院CHD患儿46例,并根据纽约大学儿童HF指数(NYU PHFI)的评价标准将其分成3组:无HF组(15例)、轻度HF组(16例)、中重度HF组(15例)。选取同期25例健康儿童作为健康对照组。分别留取各组儿童空腹静脉血2 mL,应用ELISA法测定其血浆NT-proBNP水平,同时测定其左心室射血分数(LVEF)、二尖瓣舒张早期流速峰值/二尖瓣舒张晚期流速峰值(E/A值)。分析其血浆NT-proBNP水平与HF严重程度及LVEF、E/A值的相关性。结果血浆NT-proBNP水平与HF严重程度呈明显正相关(r=0.82,P<0.01),HF程度越重,血浆NT-proBNP水平升高越显著;中重度HF组NT-proBNP水平显著高于轻度HF组(P<0.01),轻度HF组NT-proBNP水平显著高于无HF组(P<0.01),无HF组NT-proBNP水平显著高于健康对照组(P<0.05)。血浆NT-proBNP水平与LVEF呈负相关(r=-1.20,P<0.01)。结论血浆NT-proBNP水平随着HF的严重程度增加而升高,检测血浆NT-proBNP对评估CHD并HF患儿病情严重程度及判断预后具有重要临床意义。
Objective To investigate the changes of plasma NT-proBNP level in children with congenital heart disease (CHD) and heart failure (HF) and to analyze the relationship between the NT-proBNP and the severity of HF and to evaluate the cardiac function the value of. Methods Forty-six CHD children admitted to our hospital from June 2008 to June 2011 were divided into three groups according to the New York University Children’s HF Index (NYU PHFI): HF-free group (15 cases), mild HF group (16 cases), moderate and severe HF group (15 cases). Twenty-five healthy children at the same period were selected as healthy control group. Blood samples were collected from 2 mL of fasting venous blood in each group, and the level of plasma NT-proBNP was measured by ELISA. The left ventricular ejection fraction (LVEF), mitral early diastolic velocity / mitral diastolic velocity peak (E / A value). The correlation between plasma NT-proBNP level and severity of HF, LVEF and E / A was analyzed. Results The level of plasma NT-proBNP was positively correlated with the severity of HF (r = 0.82, P <0.01). The more severe HF was, the more obvious the plasma NT-proBNP was. The level of NT-proBNP was significantly higher The levels of NT-proBNP in mild HF group were significantly higher than those in HF group (P <0.01). The levels of NT-proBNP in HF group were significantly higher than those in healthy control group (P <0.05). Plasma NT-proBNP levels were negatively correlated with LVEF (r = -1.20, P <0.01). Conclusion The plasma NT-proBNP level increases with the severity of HF. Detecting plasma NT-proBNP has important clinical significance in assessing the severity of the disease and prognosis in children with CHD and HF.