血清BNP、VEGF、TGF-β1水平变化在新生儿持续性肺动脉高压病情评估中的临床意义

目的 探讨血清脑钠肽(BNP)、血管生长因子(VEGF)及转化生长因子-β1(TGF-β1)水平变化与新生儿持续性肺动脉高压(PPHN)患儿病情的关系。 方法 选择2017年3月—2018年6月郑州大学第一附属医院收治的PPHN患儿95例作为观察组,并按肺动脉压力分为3组:轻度(32例)、中度(33例)、重度(30例),另选同期分娩足月正常新生儿95例为对照组。测定观察组治疗前后及对照组血清BNP、VEGF、TGF-β1水平,分析其与PPHN的相关性。 结果 治疗前观察组血清BNP、VEGF、TGF-β1水平显著高于对照组(均P<0.05),治疗后观察组血清BNP、VEGF、TGF-β1水平明显低于治疗前(均P<0.05),重度组患儿血清BNP、VEGF、TGF-β1水平明显高于轻度与中度组(均P<0.05)。血清BNP和血清VEGF与PPHN病情严重程度呈高度正相关(r=0.908,P=0.013;r=0.835,P=0.001),血清TGF-β1与PPHN病情严重程度呈中度正相关(r=0.697,P=0.002)。血清BNP、VEGF、TGF-β1水平预测患儿不良预后的敏感性分别为88.97%、85.52%、80.26%,特异性分别为91.13%、86.39%、82.52%,准确度分别为87.62%、84.36%、77.58%。 结论 血清BNP、VEGF及TGF-β1水平与新生儿持续性肺动脉高压病情严重程度呈正相关,对患儿病情及预后评估具有较高的价值。 

Clinical significance of serum BNP,VEGF and TGF-β1 levels in the evaluation of persistent pulmonary hypertension in the newborns

Objective To investigate the relationship between serum levels of brain natriuretic peptide(BNP), vascular endothelial growth factor(VEGF) and transforming growth factor-β1(TGF-β1) and the condition of the newborns with persistent pulmonary hypertension(PPHN). Methods From March 2017 to June 2018, 95 children with PPHN who were admitted to the First Affiliated Hospital of Zhengzhou University in Henan Province were selected as an observation group, which were assigned into mild group(32 cases), moderate group(33 cases) and severe group(30 cases) according to pulmonary artery pressure. In the meanwhile, 95 cases of normal newborns were selected as the control group. The serum levels of BNP, VEGF and TGF-β1 were measured before and after the treatment in the observation group, and their correlation with PPHN was analyzed. Results The levels of serum BNP, VEGF and TGF-β1 in the observation group before the treatment were significantly higher than those in the control group(all P<0.05). After the treatment, the levels of serum BNP, VEGF and TGF-β1 in the observation group decreased significantly(all P<0.05). The levels of serum BNP, VEGF and TGF-β1 in the severe group were significantly higher than those in the mild and moderate group(all P<0.05). Serum BNP and VEGF were highly positively correlated with the severity of PPHN(r=0.908, P=0.013; r=0.835, P=0.001), serum TGF-beta 1 was moderately positively correlated with the severity of PPHN(r=0.697, P=0.002). The sensibility of serum BNP, TGF-β1 and VEGF levels in predicting the prognosis of PPHN were 88.97%, 86.39% and 80.26%, respectively, and the specificities were 91.13%, 86.39% and 82.52%, respectively. The accuracy was 87.62% and 84.36% and 77.58%, respectively. Conclusion The serum levels of BNP, VEGF and TGF-β1 are positively correlated with the severity of PPHN, with high value in evaluating the condition and prognosis of children.