中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2009年
6期
462-465
,共4页
婴儿,新生%脓毒症%重症监护病房,新生儿%心肌损伤%脑钠肽%氮端脑钠肽
嬰兒,新生%膿毒癥%重癥鑑護病房,新生兒%心肌損傷%腦鈉肽%氮耑腦鈉肽
영인,신생%농독증%중증감호병방,신생인%심기손상%뇌납태%담단뇌납태
Infant,newborn%Sepsis%Intensive care units,neonatal%Myocardial injury%Brain natriuretic peptide%N-terminal pro-B-type natriuretic peptide
目的 探讨新生儿败血症并发心肌损伤时血浆脑钠肽(brain natriuretic peptide,BNP)和氮端脑钠肽(N-terminal pro-B-type natriuretic peptide,NT-proBNP)在败血症的不同时期血浆水平的变化及在不同胎龄儿中表达水平的差异,为新生儿败血症心肌损伤提供早期诊断的可靠实验室指标.方法 将临床诊断新生儿败血症的患儿96例,分为心肌损伤组和非心肌损伤组,发病第2、5、10天采用酶联免疫吸附法分别检测血浆BNP和NT-proBNP的水平,在新生儿败血症并心肌损伤急性期(即入院第5天)将BNP和NT-proBNP血浆水平与肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)和肌钙蛋白Ⅰ(troponinI,cTnI)比较,同时分析不同胎龄对血浆脑钠肽和氮端脑钠肽水平的影响.结果 BNP值在入院第5天,心肌损伤组和非心肌损伤组比较差异有统计学意义(P<0.05),其值分别为(215.5±69.6)pmol/L和(119.3±37.4)pmol/L;第2、10天比较差异无统计学意义(P>0.05),其值分别为(58.7±15.7)pmol/L和(61.7±18.1)pmol/L,(95.1±25.3)pmol/L和(74.5±19.3)pmol/L.NT-proBNP在第2、5、10天两组比较差异均有统计学意义(P<0.05),以第5天的升高较明显.NT-proBNP值第5天心肌损伤组和非心肌损伤组分别为(315.5±69.7)pmol/L和(179.3±27.5)pmol/L.入院第5天,BNP值两组分别为(215.5±69.6)pmol/L和(119.3±37.4)pmol/L,NT-proBNP值两组分别为(315.5±69.7)pmol/L和(179.3±27.5)pmol/L,cTnI值两组分别为(1.57±0.39)μg/L和(0.55±0.2)μg/L,CK-MB两组间比较差异无统计学意义(P>0.05).不同胎龄儿中BNP和NT-proBNP的值以早产儿最高,早产儿BNP值为(159.5±39.6)pmol/L,NT-proBNP值为(238.5±49.7)pmol/L,三组比较差异有统计学意义(P<0.05).结论 新生儿败血症发生心肌损伤时血浆腩钠肽和氮端脑钠肽在败血症急性期明显升高,以早产儿升高最明显,在败血症早期以NT-proBNP的升高较明显,可与肌钙蛋白Ⅰ联合早期诊断新生儿败血症心肌损伤.
目的 探討新生兒敗血癥併髮心肌損傷時血漿腦鈉肽(brain natriuretic peptide,BNP)和氮耑腦鈉肽(N-terminal pro-B-type natriuretic peptide,NT-proBNP)在敗血癥的不同時期血漿水平的變化及在不同胎齡兒中錶達水平的差異,為新生兒敗血癥心肌損傷提供早期診斷的可靠實驗室指標.方法 將臨床診斷新生兒敗血癥的患兒96例,分為心肌損傷組和非心肌損傷組,髮病第2、5、10天採用酶聯免疫吸附法分彆檢測血漿BNP和NT-proBNP的水平,在新生兒敗血癥併心肌損傷急性期(即入院第5天)將BNP和NT-proBNP血漿水平與肌痠激酶同工酶(creatine kinase isoenzyme,CK-MB)和肌鈣蛋白Ⅰ(troponinI,cTnI)比較,同時分析不同胎齡對血漿腦鈉肽和氮耑腦鈉肽水平的影響.結果 BNP值在入院第5天,心肌損傷組和非心肌損傷組比較差異有統計學意義(P<0.05),其值分彆為(215.5±69.6)pmol/L和(119.3±37.4)pmol/L;第2、10天比較差異無統計學意義(P>0.05),其值分彆為(58.7±15.7)pmol/L和(61.7±18.1)pmol/L,(95.1±25.3)pmol/L和(74.5±19.3)pmol/L.NT-proBNP在第2、5、10天兩組比較差異均有統計學意義(P<0.05),以第5天的升高較明顯.NT-proBNP值第5天心肌損傷組和非心肌損傷組分彆為(315.5±69.7)pmol/L和(179.3±27.5)pmol/L.入院第5天,BNP值兩組分彆為(215.5±69.6)pmol/L和(119.3±37.4)pmol/L,NT-proBNP值兩組分彆為(315.5±69.7)pmol/L和(179.3±27.5)pmol/L,cTnI值兩組分彆為(1.57±0.39)μg/L和(0.55±0.2)μg/L,CK-MB兩組間比較差異無統計學意義(P>0.05).不同胎齡兒中BNP和NT-proBNP的值以早產兒最高,早產兒BNP值為(159.5±39.6)pmol/L,NT-proBNP值為(238.5±49.7)pmol/L,三組比較差異有統計學意義(P<0.05).結論 新生兒敗血癥髮生心肌損傷時血漿腩鈉肽和氮耑腦鈉肽在敗血癥急性期明顯升高,以早產兒升高最明顯,在敗血癥早期以NT-proBNP的升高較明顯,可與肌鈣蛋白Ⅰ聯閤早期診斷新生兒敗血癥心肌損傷.
목적 탐토신생인패혈증병발심기손상시혈장뇌납태(brain natriuretic peptide,BNP)화담단뇌납태(N-terminal pro-B-type natriuretic peptide,NT-proBNP)재패혈증적불동시기혈장수평적변화급재불동태령인중표체수평적차이,위신생인패혈증심기손상제공조기진단적가고실험실지표.방법 장림상진단신생인패혈증적환인96례,분위심기손상조화비심기손상조,발병제2、5、10천채용매련면역흡부법분별검측혈장BNP화NT-proBNP적수평,재신생인패혈증병심기손상급성기(즉입원제5천)장BNP화NT-proBNP혈장수평여기산격매동공매(creatine kinase isoenzyme,CK-MB)화기개단백Ⅰ(troponinI,cTnI)비교,동시분석불동태령대혈장뇌납태화담단뇌납태수평적영향.결과 BNP치재입원제5천,심기손상조화비심기손상조비교차이유통계학의의(P<0.05),기치분별위(215.5±69.6)pmol/L화(119.3±37.4)pmol/L;제2、10천비교차이무통계학의의(P>0.05),기치분별위(58.7±15.7)pmol/L화(61.7±18.1)pmol/L,(95.1±25.3)pmol/L화(74.5±19.3)pmol/L.NT-proBNP재제2、5、10천량조비교차이균유통계학의의(P<0.05),이제5천적승고교명현.NT-proBNP치제5천심기손상조화비심기손상조분별위(315.5±69.7)pmol/L화(179.3±27.5)pmol/L.입원제5천,BNP치량조분별위(215.5±69.6)pmol/L화(119.3±37.4)pmol/L,NT-proBNP치량조분별위(315.5±69.7)pmol/L화(179.3±27.5)pmol/L,cTnI치량조분별위(1.57±0.39)μg/L화(0.55±0.2)μg/L,CK-MB량조간비교차이무통계학의의(P>0.05).불동태령인중BNP화NT-proBNP적치이조산인최고,조산인BNP치위(159.5±39.6)pmol/L,NT-proBNP치위(238.5±49.7)pmol/L,삼조비교차이유통계학의의(P<0.05).결론 신생인패혈증발생심기손상시혈장남납태화담단뇌납태재패혈증급성기명현승고,이조산인승고최명현,재패혈증조기이NT-proBNP적승고교명현,가여기개단백Ⅰ연합조기진단신생인패혈증심기손상.
Objective Neonatal sepsis can cause multiple organ dysfunction syndrome, especially including myocardial injury and heart failure. In this study, the authors observed the changes and the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide in myocardial injury of neonatal sepsis at the different stages to search for the early diagnostic index of myocardial injury and heart failure in patients with neonatal septicemia. Method The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were determined in 96 newborns with neonatal septicemia according to the diagnosis and treatment program of neonatal septicemia in 2003. The 96 cases were divided into myocardial injury group and non-myocardial injury group. Every newborn was tested for the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide with enzyme-linked immunosorbent assay (ELISA) on the second day, fifth day and tenth day of septicemia and in the different gestational age infants. Meanwhile, the results were eompaired to ereatine kinase isoenzyme and troponin Ⅰ. Result The levels of plasma brain natriuretie peptide and N-terminal pro-B-type natriuretic peptide were significantly different between myocardial injury group and non-myocardial injury group at the fifth day (P<0.05), especially the levels of plasma N-terminal pro-B-type natriuretic peptide were significantly elevated at the early stage( on the second day) between the two groups(P<0.05). On the fifth day, The values of plasma N-terminal pro-B-type natriuretic peptide were (315.5±69.7) pmol/L in myocardial injury group, but the value of non-myocardial injury group was (179.3±27.5) pmol/L. On the frith day, the results of plasma brain natriuretic peptide, N-terminal pro-B-type natriuretie peptide and tropenin Ⅰ were significantly different and had statistical significance between the myocardial injury group and non-myocardial injury group(P < 0.05), while the results of creatine kinase isoenzyme had no statistically significant difference(P>0.05). The values of plasma brain natriuretic peptide were respectively (215.5±69.6)pmol/L and( 119.3±37.4) pmol/L, While N-terminal pro-B-type natriuretic peptide were (315.5±69.7) pmoL/L and ( 179.3±27.5) pmol/L in the two groups. The value of troponin Ⅰ was ( 1.57±0.39) μg/L in the myocardial injury group and that in the non-myocardial injury group was (0.55 ±0.2 ) μg/L. The values of creatine kinase isoenzyme were (33.3±10.1) u/L in the myocardial injury group, but that of non-myocardial injury group was ( 17.4±8. 5 ) u/L In the different gestational age infants, the values of plasma brain natduretic peptide and N-terminal pro-B-type natriuretie peptide of premature infants were the highest in the three groups. The values of plasma brain natriuretie peptide and N-terminal pro-B-type natriuretie peptide were (159.5±39.6) pmol/L and (238.5±49.7)pmol/L in premature infants. Conclusion The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretie peptide evidently increased in myocardial injury of neonatal sepsis, especially in premature infants. The increase of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretie peptide may be helpful in early diagnosis of the myocardial injury of neonatal sepsis associated with cTnI. N-terminal pro-B-type natriuretie peptide may become a useful index to diagnose the myocardial injury and should be widely used in the neonatal intensive care unit.
