B型脑钠肽与N端脑钠肽前体在新生儿窒息后心力衰竭辅助诊断中的比较

目的：观察并比较B型脑钠肽（ B type brain natriuretic peptide，BNP ）、N端脑钠肽前体（ N-terminal pro-brain natriuretic peptide，NT-proBNP）对新生儿窒息后发生心力衰竭的辅助诊断价值，优化早期临床诊断。方法回顾性分析2013年1月至2015年10月我院收治的124例出生后窒息新生儿的临床资料，根据有无心力衰竭分为心衰组53例和对照组71例，48 h内股静脉穿刺采血检测并比较，将存在差异的指标进行Logistic回归分析，计算BNP、NT-proBNP与窒息患儿左室射血分数的相关性，通过受试者工作特征（ ROC）曲线计算BNP、NT-proBNP对新生儿窒息后发生心力衰竭的诊断效能。结果心衰组患儿BNP[（835.8±154.7）pg／ml vs.（235.4±38.5）pg／ml]、NT-proBNP（25903.8 pg／ml vs.6974.5 pg／ml）、心肌肌钙蛋白T[（0.21±0.06）ng／ml vs.（0.11±0.03）ng／ml]、CK-MB[（61.3±11.7）U／L vs.（40.8±9.5）U／L]均显著高于对照组（P﹤0.05）；Logistic回归分析提示BNP、NT-proBNP与窒息新生儿发生心力衰竭密切相关（ ORBNP ＝3.013，P﹤0.001；ORNT-proBNP ＝3.808，P＝0.006）；BNP、NT-proBNP与左室射血分数呈明显负相关（ rBNP ＝-0.650，P ＝0.007；rNT-proBNP ＝-0.721，P ﹤0.001）。ROC曲线提示BNP、NT-proBNP对新生儿窒息后发生心力衰竭的诊断效能分别为0.868、0.911，截断值分别取268.8 pg／ml、3972.3 pg／ml时诊断一致性最高。结论血浆BNP与NT-proBNP均是反映新生儿窒息后发生心力衰竭的高效特异性指标，对新生儿心力衰竭具有辅助诊断价值，相比较而言NT-proBNP 的早期诊断意义更高。

Comparative study of B type brain natriuretic peptide and N-terminal pro-brain natriuretic peptide in ;the auxiliary diagnosis of heart failure after neonatal asphyxia

Objective To observe and compare the value of B brain natriuretic peptide( BNP)and N-terminal pro-brain natriuretic peptide( NT-proBNP)in the diagnosis of heart failure after neonatal asphyxia, and to optimize early clinical diagnosis. Methods A retrospective analysis was conducted on 124 neonatal asphyxia cases from January 2013 to October 2015,who were divided into heart failure group(53 cases)and control group(71 cases)according to whether complicated with heart failure. Comparison was conducted on BNP,NT-proBNP,cardiac troponin T( cTnT),creatine kinase isoenzyme( CK-MB)through blood sam-pling from femoral vein puncture within 48 h. And Logistic regression analysis was introduced into explore effecting factors of heart failure,besides,correlations between BNP,NT-proBNP and left ventricular ejection fraction( LVEF)of asphyxia children were calculated,and receiver operating characteristic curve( ROC)was introduced into analyzing of BNP and NT-proBNP for diagnostic efficacy of heart failure after neonatal asphyxia. Results Heart failure group whose BNP[(835. 8 ± 154. 7)pg/ml vs. (235. 4 ± 38. 5)pg/ml], NT-proBNP(25 903. 8 pg/ml vs. 6 974. 5 pg/ml),cTnT[(0. 21 ± 0. 06)ng/ml vs. (0. 11 ± 0. 03)ng/ml], CK-MB[(61. 3 ± 11. 7)U/L vs. (40. 8 ± 9. 5)U/L]were significantly higher than those of control group ( P﹤0. 05). Logistic regression analysis indicated BNP and NT-proBNP were closely related with newborn heart failure(ORBNP =3. 013,P﹤0. 001;ORNT-proBNP =3. 808,P=0. 006). BNP and NT-proBNP were both significantly negatively correlated with LVEF(rBNP = -0. 650,P=0. 007;rNT-proBNP = -0. 721,P﹤0. 001). The ROC curve indicated the diagnostic efficacy of BNP and NT-proBNP for heart failure after neonatal as-phyxia were 0. 868,0. 911,with the highest diagnosis cut-off value were 268. 8 pg/ml,3 972. 3 pg/ml,respec-tively. Conclusion BNP and NT proBNP are specific indicators reflecting heart failure after neonatal as-phyxia,and NT-proBNP with higher auxiliary diagnostic efficacy comparatively.