CAJ | 학술논문

目的：研究危重症婴儿血清 N 末端脑利钠肽前体( N-terminal pro-brain natriuretic peptide,NT-pro-BNP)水平对预后的预测价值。方法选择2013年1月至2014年1月本院PICU收治的婴儿81例,计算入院24h内小儿危重病例评分( pediatric critical illness score,PCIS)的最差值及功能障碍的器官数目。根据PCIS评分分为3组：极危重组(≤70分)25例、危重组(80~71分)30例、非危重组(>80分)26例；按患儿预后分为存活组68例和死亡组13例。测定患儿入院第1天、第3天及病情恢复期的血清NT-pro-BNP浓度,观察患儿血清NT-pro-BNP水平与PCIS及功能障碍器官数目的相关性以及对患儿预后的影响。结果在入院第1天、第3天及恢复期,极危重组、危重组、非危重组3组患儿组间血清NT-pro-BNP水平比较,差异均有统计学意义(P<0．01)。同时3组患儿在疾病不同时期组内血清NT-pro-BNP水平比较,差异亦有统计学意义(P<0．01)。死亡组PCIS分值明显低于生存组,血清NT-pro-BNP水平及功能障碍的器官数目均明显高于生存组。生存组第1天与第3天的血清NT-pro-BNP 水平比较,差异无统计学意义(P>0．05)；死亡组第3天血清NT-pro-BNP水平明显高于存活组,差异有统计学意义(P<0．01)。入院第1天和第3天NT-pro-BNP水平与PCIS分值呈显著负相关(r=-0．59,P<0．01；r=-0．66,P<0．01),入院第1天和第3天血清NT-pro-BNP水平与功能障碍的器官数目呈显著正相关(r=0．40,P<0．05；r=0．57,P<0．01)。结论危重症婴儿血清NT-pro-BNP与病情危重程度密切相关,可作为判断病情的指标。
목적：연구위중증영인혈청 N 말단뇌리납태전체( N-terminal pro-brain natriuretic peptide,NT-pro-BNP)수평대예후적예측개치。방법선택2013년1월지2014년1월본원PICU수치적영인81례,계산입원24h내소인위중병례평분( pediatric critical illness score,PCIS)적최차치급공능장애적기관수목。근거PCIS평분분위3조：겁위중조(≤70분)25례、위중조(80~71분)30례、비위중조(>80분)26례；안환인예후분위존활조68례화사망조13례。측정환인입원제1천、제3천급병정회복기적혈청NT-pro-BNP농도,관찰환인혈청NT-pro-BNP수평여PCIS급공능장애기관수목적상관성이급대환인예후적영향。결과재입원제1천、제3천급회복기,겁위중조、위중조、비위중조3조환인조간혈청NT-pro-BNP수평비교,차이균유통계학의의(P<0．01)。동시3조환인재질병불동시기조내혈청NT-pro-BNP수평비교,차이역유통계학의의(P<0．01)。사망조PCIS분치명현저우생존조,혈청NT-pro-BNP수평급공능장애적기관수목균명현고우생존조。생존조제1천여제3천적혈청NT-pro-BNP 수평비교,차이무통계학의의(P>0．05)；사망조제3천혈청NT-pro-BNP수평명현고우존활조,차이유통계학의의(P<0．01)。입원제1천화제3천NT-pro-BNP수평여PCIS분치정현저부상관(r=-0．59,P<0．01；r=-0．66,P<0．01),입원제1천화제3천혈청NT-pro-BNP수평여공능장애적기관수목정현저정상관(r=0．40,P<0．05；r=0．57,P<0．01)。결론위중증영인혈청NT-pro-BNP여병정위중정도밀절상관,가작위판단병정적지표。
Objective To explore the prognostic value of N-terminal pro-brain natriuretic peptide ( NT-pro-BNP) levels in critically ill infants. Methods Eighty-one critically ill infants were enrolled from January 2013 to January 2014 in pediatric intensive care unit. The minimum of pediatric critical illness score ( PCIS) and the number of dysfunction organs were calculated within 24 hour after admission. According to PCIS,the critically ill infants were divided into extremely critical group(PCIS≤70,n=25),critical group (PCIS 71-80,n=30)and non-critical group(PCIS>80,n=26). According to the prognosis,the critically ill infants were divided into survival group (n=68)and death group(n=13). The serum NT-pro-BNP levels were determined on the first day,third day and convalescent phase. The relationships of serum NT-pro-BNP levels with PCIS and the number of dysfunction organs and prognosis were observed. Results The study showed statistical significances of serum NT-pro-BNP levels among the extremely critical group, critical group and non-critical group,whether on the first day,or on the third day and convalescent phase(P<0. 01). There were statistical significances of serum NT-pro-BNP levels among different stages of the disease in each group(P<0. 01). Compared with survival group,PCIS was significantly lower and the serum NT-pro-BNP levels and the number of dysfunction organs were significantly higher in death group. The serum NT-pro-BNP level on the third day was higher than that on the first day in death group ( P<0. 01 ) , while no significant difference was found in survival group. The serum NT-pro-BNP levels on the first day and the third day and PCIS were negatively correlated(r= -0. 59,P<0. 01;r= -0. 66,P<0. 01). The serum NT-pro-BNP levels on the first day and the third day and the number of dysfunction organs were positively correlated(r=0. 40,P<0. 05;r=0. 57,P<0. 01). Conclusion The serum NT-pro-BNP levels of the critically ill infants are correlated with disease severity,and can be useful for assessing the severity of critical illness.