Cardiac function in children post-orthotopic liver transplantation: echocardiographic parameters and biochemical markers of subclinical cardiovascular damage

Tacrolimus and cyclosporin A (CsA), the mainstay of preventive therapy for solid organ rejection, may cause various side-effects, such as hypertension and nephrotoxicity. Furthermore, tacrolimus is associated with cardiac hypertrophy. In the immediate post-transplant period, both drugs raise the levels of Endothelin-1 (ET), a potent vasoconstrictor; and of B-type Natriuretic Peptide (BNP), a sensitive marker of left ventricular volume overload, which may precede echocardiographic changes of cardiac dysfunction. The aim of the study was to investigate the presence of cardiac damage, by echocardiography and by the biochemical markers BNP and ET, in post-orthotopic liver transplantation (OLT) children, receiving long-term immunosuppressive therapy. ET (ELISA) and BNP (RIA) were measured in plasma of 18 children, post-OLT and 18 healthy controls. Children post-OLT were echocardiographically assessed for left ventricular mass (interventricular septum and posterior wall dimensions), systolic function (ejection fraction, fractional shortening) and diastolic parameters (mitral valve E and A waves, deceleration time, isovolumic relaxation time). None of the post-transplant recipients had a history or physical examination consistent with cardiac disease and all recipients were normotensive. Echocardiography revealed no systolic or diastolic dysfunction in any of the recipients. The mean ET and BNP levels tended to be higher among children post-liver transplant, compared with healthy controls (ET: 4.22 +/- 5.35 pg/mL vs. 2.1 +/- 2.0 pg/mL; BNP: 7.05 +/- 4.4 pg/mL vs. 5.87 +/- 2.0 pg/mL, respectively, mean +/- s.d.) although differences did not reach statistical significance. Three children (17%) had elevated BNP and/or ET levels. A strong correlation was observed between ET and BNP levels in post-OLT children (r = 0.79, p < or = 0.05). No correlation was found between ET or BNP levels and echocardiographic findings. In children receiving long-term immunosuppressive therapy post-OLT, although cardiac function is grossly preserved, ET and BNP levels tend to be higher than in healthy, age-matched children. Thus, elevated levels of BNP and/or ET may identify patients with early cardiac damage.     

小儿血清脑钠素正常参考范围

目的：国外研究显示了血清脑钠素-BNP32和氨基末端脑钠肽(NT-proBNP)水平在小儿心力衰竭诊治中的意义。然而,由于小儿BNP32和NT-proBNP正常范围的缺乏导致其在小儿心脏疾病中的应用受到了限制。该研究测定了正常小儿的BNP32和NT-proBNP水平,为临床应用提供参考。方法：用酶联免疫方法分别测定190名健康小儿血清BNP32和NT-proBNP水平,男95名,女95名,年龄10.60±4.12岁,全部受检者均经体检、心电图等检查证明身体健康。结果：小儿血清BNP32浓度为51.89±48.36pg/mL,第10百分位为27.00pg/mL,第90百分位为75.00pg/mL。血清NT-proBNP浓度为246.04±67.27fmol/mL。两种均无性别间的差异(P>0.05),虽然,女童青春成熟期BNP32和NT-proBNP浓度高于青春前,女童脑钠素高于男童,但均未显示有统计学上的显著差异。结论：该文在国内首次用酶联免疫方法测定中国小儿BNP32和NT-proBNP正常范围,小儿NT-proBNP数据较BNP更为稳定、可靠,为脑钠素水平临床测定提供有价值的参考。     

充血性心力衰竭与重症肺炎患儿血清脑钠素浓度变化的研究

目的：B型利钠肽即脑钠素(B-typeorbrainnatriureticpeptide,BNP)在成人充血性心力衰竭(con-gestiveheartfailure,CHF)时血浆浓度显著升高,对成人CHF有重要诊断价值,对成人急性呼吸困难有重要的鉴别诊断价值。在小儿有关BNP的研究不多,该实验旨在研究小儿CHF及肺炎时血清BNP浓度变化,探讨BNP对小儿急性呼吸困难的鉴别诊断价值;进一步探讨小儿重症肺炎是否会合并心衰,为肺炎合并心衰的诊断寻找客观指标。方法：将65例有呼吸困难症状的患儿分为3组CHF组(即心源性呼吸困难组)24例;肺炎组(即肺源性呼吸困难组)23例;临床诊断肺炎心衰组18例。对10例肺炎合并心衰患儿在病情平稳2~3d后再次收集血清。正常对照组15例。用ELISA法测血清BNP浓度。结果：CHF组血清BNP浓度显著高于临床诊断肺炎心衰组、肺炎组及正常组(P<0.01);临床诊断肺炎心衰组显著高于肺炎组(P<0.01)及正常组(P<0.01),肺炎组与正常组比较差异无显著性。BNP对心源性呼吸困难鉴别诊断的受试者作业特征曲线(receiveoperatorcharacteristic,ROCcurve)下面积是0.978(P<0.01);BNP以49pg/mL为诊断界值,对呼吸困难由CHF引起的诊断敏感度是87.5%,特异度是95.8%;临床诊断肺炎心衰的18例患儿中,BNP浓度>49pg/mL的11例,其BNP浓度为172.08±56.47pg/mL,显著高于肺炎组(P<0.01),与CHF组相比无差异;这11例中有10例治疗后复查血清BNP,其浓度为26.12±15.71pg/mL,低于治疗前(P<0.01)。另7例血清BNP浓度为20.46±11.78pg/mL,与肺炎组及正常组相比差异无显著性(均P>0.05)。结论：BNP浓度检测对小儿呼吸困难是否由CHF引起有鉴别诊断价值;小儿重症肺炎时可以合并心力衰竭;BNP检测可鉴别小儿重症肺炎是否合并心力衰竭。     

先天性心脏病患儿血浆脑钠肽水平与左心功能的关系

目的：探讨先天性心脏病（先心病）患儿血浆脑钠肽（BNP）水平与左心功能的相关性及其临床意义。方法：回顾性分析41例先心病患儿的临床资料,根据有无合并充血性心力衰竭（CHF）将其分为2组：一组为合并CHF组（n=21）,另一组为无合并CHF组（n=20）。用化学发光免疫分析法测定血浆BNP水平,超声心动图测定左室射血分数(LVEF)。结果：①先心病合并CHF组患儿血浆BNP水平为1353（926,2978）pg/mL,显著高于先心病无合并CHF组［149（75,242）pg/mL］（P<0.01);先心病合并CHF组患儿LVEF为60（53,65）%,显著低于先心病无合并CHF组68（64,72）%（P<0.01)。②先心病患儿血浆BNP水平与LVEF呈显著负相关(r=-0.652,P<0.01)。结论：BNP可作为反映左心功能受损的敏感指标,与心功能状态有明显相关性,其检测对先心病合并CHF患儿左心功能的判断具有重要意义。     

先天性心脏病肺动脉高压患儿左室舒张功能与血浆脑利钠水平的相关性研究

目的：探讨先天性心脏病 (CHD)合并肺动脉高压 (PAH) 患儿脑利钠肽（BNP）水平及与左室舒张功能的关系。方法：对95例CHD继发有PAH的患儿和42例无PHA的CHD患儿（对照组）的多普勒超声心动图资料与其血浆BNP水平进行对比分析。结果：与对照组相比, PAH组的左室舒张末内径（LVDd ）、右室舒张末内径（RVDd） 和肺动脉内径（PAd）明显增大(P<0.05),三尖瓣返流（VTR）速度增快及肺动脉收缩压（PASP）升高(P<0.05)。与对照组比较,PASP组患儿二尖瓣口多普勒血流频谱A峰流速（AV）、A峰流速积分（AVI）和E峰流速积分（EVI）及AV/EV和AVI/EVI比均逐渐明显增大(P<0.01);左室等容舒张时间明显延长(LIVRT)(P<0.05)。血浆BNP水平随着PASP增高而升高,与对照组相比差异有显著性（P<0.01）。PAH组先心病患儿其肺动脉压与二尖瓣口血流频谱AV/EV比值呈正相关（P<0.01）,二尖瓣口血流参数与血浆BNP水平亦呈正相关（P<0.01）。结论：CHD合并PAH患儿左室舒张功能与血浆BNP水平呈正相关;BNP在PAH引起左室舒张功能障碍的发生发展过程中发挥了重要作用。［中国当代儿科杂志,2010,12（1）：13-16］     

Elevated Plasma Connective Tissue Growth Factor Levels in Children with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

We aimed to investigate plasma connective tissue growth factor (CTGF) levels in pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) (PAH–CHD) in children and the relationships of CTGF with hemodynamic parameters. Plasma CTGF levels were calculated in 30 children with CHD, 30 children with PAH–CHD and 25 health volunteers, using the subtraction method. Cardiac catheterization was performed to measure clinical hemodynamic parameters. Plasma CTGF levels were significantly higher in PAH–CHD than in those with CHD and health volunteers (p < 0.01). In cyanotic PAH–CHD, plasma CTGF levels were significantly elevated compared with acyanotic PAH–CHD in the same group (p < 0.05). Plasma CTGF levels showed positive correlation with B-type natriuretic peptide (BNP) in PAH–CHD (r = 0.475, p < 0.01), while oxygen saturation was inversely related to plasma CTGF levels (r = ?0.436, p < 0.05). There was no correlation between CTGF and hemodynamic parameters. Even though the addition of CTGF to BNP did not significantly increase area under curve for diagnosis of PAH–CHD compared with BNP alone (p > 0.05), it revealed a moderately better specificity, positive predictive value and positive likelihood ratio than BNP alone. Plasma CTGF levels could be a promising diagnostic biomarker for PAH–CHD in children.     

Plasma brain natriuretic peptide concentrations in patients with Kawasaki disease

BACKGROUND: Brain natriuretic peptide (BNP) is a cardiac hormone and plasma levels of it increase in patients with congestive heart failure and in those with acute myocardial infarction. Kawasaki disease (KD) is a well-known generalized vasculitis and the most prominent features of this disease are the cardiovascular manifestations, which involve the pericardium, myocardium, endocardium and coronary arteries. It was hypothesized that the plasma concentrations of BNP in patients with KD might be increased and that plasma BNP might be a useful biological marker of cardiovascular manifestations in patients with KD. METHODS: Blood was obtained to measure and compare plasma BNP concentrations in the acute (n = 32) and convalescent (n = 35) phases of KD and in the acute phase of the patients with viral infection (n = 26), which included adenovirus, influenza, measles and herpes group virus infection. In patients with KD, two-dimensional echocardiography was performed to check for pericardial effusion and coronary arterial lesions and to measure the dimensions of the left ventricle at diastole and the shortening fraction of the left ventricle (LVSF). RESULTS: The mean plasma BNP concentration in patients with KD in the acute phase was 55.0 +/- 39.5 pg/mL, but was 6.8 +/- 7.3 pg/mL in patients with viral infection. The plasma BNP concentration in patients with KD in the acute phase was significantly higher than in patients with viral infection (P < 0.0001). In 31 cases of KD, the plasma BNP concentrations were measured both in the acute and convalescent phases. The mean plasma BNP concentration in the acute phase of KD was 55.3 +/- 40.1 pg/mL and in the convalescent phase was 5.9 +/- 5.7 pg/mL. The level of plasma BNP decreased significantly in the convalescent phase (P < 0.0001). The mean BNP level in patients with KD with pericardial effusion (n = 8) in the acute phase was 80.3 +/- 43.4 pg/mL and that in patients without pericardial effusion (n = 24) was 46.5 +/- 35.1 pg/mL. The BNP level in patients with pericardial effusion was significantly higher than that of patients without pericardial effusion (P < 0.05). There was no significant correlation between the plasma concentrations of BNP in the acute phase of KD and LVSF (r = -0.161, P = 0.39, n = 31). CONCLUSION: It was shown that the plasma BNP concentration increased in the acute phase of KD and decreased to within normal range in the convalescent phase. Further examinations are needed to clarify the mechanism by which the elevated levels of plasma BNP occur in the acute phase of KD. However, plasma BNP might be a useful biological marker of the cardiovascular manifestations in patients with KD.     

B-Type Natriuretic Peptide Levels in Congenital Heart Disease

The objective of this study was to evaluate the potential role of B-type natriuretic peptide (BNP) levels in children with congenital heart disease undergoing cardiac catheterization. Measurement of plasma BNP concentration has been shown to be useful in the diagnosis, risk stratification, and management of adult patients with congestive heart failure, but little is known about the role of BNP in children with structural congenital heart disease. We measured plasma BNP levels using the Triage BNP test in patients with congenital heart disease referred for diagnostic or interventional cardiac catheterization. Plasma BNP concentration was measured in 96 children and 11 adults 19 years old (7.9 ± 8.3 years) undergoing heart catheterization for underlying congenital heart disease. BNP levels ranged from <5 to >1300 pg/ml, with a median BNP concentration of 19.0 pg/ml. Baseline BNP concentrations were >100.0 pg/ml on 19 occasions in 17 patients. The pressure difference between the left ventricle and ascending aorta was 10–110 mmHg in 21 patients. BNP concentrations for this cohort ranged from <5.0 to 1060.0 pg/ml and correlated with the degree of left ventricular outflow obstruction (correlation coefficient, 0.661; p = 0.001). This study suggests that with additional research, BNP concentration may prove to be a useful clinical tool in managing children and adults with congenital heart disease.     

血清脑钠肽检测在小儿甲亢性心脏病中的诊断价值

目的：探讨血清脑钠肽（BNP）检测在小儿甲亢性心脏病（甲亢心）中的诊断价值。方法：测定并比较甲亢心28例（甲亢心组）,甲状腺功能亢进症（甲亢组）及对照组各30例小儿的血清BNP、左室射血分数（LVEF）,二尖瓣血流频谱E/A比值等指标,并以BNP为诊断指标,对小儿甲亢心进行诊断试验评价。结果：①甲亢心组和甲亢组患儿治疗前血清BNP水平均显著高于对照组（P<0.05）,LVEF及E/A比值明显低于对照组（P<0.05）,甲亢心组血清BNP水平与TT3、TT4水平呈显著正相关（r=0.801,P<0.05;r=0.578,P<0.05）,与LVEF、E/A比值呈显著负相关（r=-0.4８,P<0.05,r=-0.35,P<0.05）。②甲亢心组和甲亢组患儿治疗3个月后血清BNP、TT3、TT4显著低于治疗前（P<0.05）,LVEF、E/A比值显著高于治疗前（P<0.05）。③以BNP>323.62 pg/mL为界点诊断甲亢心的灵敏度为92.86%、特异度90.00%、阳性预测值89.66%、阴性预测值93.10%。结论：血清BNP检测是小儿甲亢心比较可靠的诊断指标,其水平的高低结合LVEF、E/A比值可反映甲亢心的严重程度以及心肌损害的程度。［中国当代儿科杂志,2009,11（8）：631-634］     

B‐type natriuretic peptide levels at birth predict cardiac dysfunction in neonates

Background: Although the B‐type natriuretic peptide (BNP) levels in the umbilical cord blood (UCB‐BNP) and amniotic fluid (AF‐BNP) of neonates may be clinically useful for identifying newborns with cardiac dysfunction, the effects of various clinical factors, such as gestational age at birth, small for gestational age (SGA), and neonatal asphyxia, on the UCB‐BNP and AF‐BNP levels have not been studied extensively. Methods: The present study sought to determine whether the UCB‐BNP and AF‐BNP levels can predict cardiac dysfunction and hypotension in preterm infants soon after birth and to evaluate the association between BNP and various clinical factors. The UCB‐BNP and AF‐BNP levels at birth were determined in 320 and 195 neonates, respectively, born to mothers with singleton pregnancies. Results: The UCB‐BNP and AF‐BNP levels in infants treated with dopamine were significantly higher than those in infants without dopamine administration (230.1 vs 33.1 pg/mL and 74.4 vs 18.1 pg/mL, respectively). Stepwise multiple regression analyses indicated that gestational age, SGA, asphyxia, and chorioamnionitis were significant independent determinants of the UCB‐BNP level. Cut‐off values of >90 pg/mL for UCB‐BNP and >36 pg/mL for AF‐BNP yielded sensitivities of 68% and 93%, respectively, and specificities of 84% and 81%, respectively, for detecting neonates who required dopamine administration after birth. Conclusion: High UCB‐BNP and AF‐BNP levels predict neonatal cardiac dysfunction soon after birth.     

Brain-type natriuretic peptide correlates with right heart pressures in a cross section of pediatric heart transplant patients

Serum brain-type natriuretic peptide level (BNP) correlates with hemodynamic parameters measured during cardiac catheterization in adult patients with heart failure. We sought to describe the relationship of BNP with invasive hemodynamic measurements and cellular rejection in children following OHT. Children undergoing catheterization for OHT surveillance had simultaneous measurement of BNP. A total of 62 subjects were studied. The median BNP was 171 pg/mL (range 19-1130). There were significant positive correlations between BNP and mean PAP (R=0.33, p=0.009), RVSP (R=0.25, p=0.05), RVEDP (R=0.29, p=0.02), and mean RAP (R=0.39, p=0.002). Rejection grade varied from 0 to 3A (58 patients < ISHLT 3A and four patients ≥ ISHLT 3A). There was no significant difference in BNP based on cellular rejection grade. In a cohort of pediatric patients after heart transplantation, BNP correlates with direct measurements of right-sided pressures, but not with other hemodynamic measurements, time from transplant or rejection grade. This suggests that BNP may have a complimentary role in the monitoring of children following heart transplantation.     

γ-氨基丁酸治疗对哮喘患儿血浆P物质和降钙素基因相关肽含量的影响

目的：探讨γ-氨基丁酸（GABA）治疗前后哮喘患儿血浆P物质（SP）和降钙素基因相关肽(CGRP)含量的变化。方法：75例哮喘患儿随机分为GABA治疗组（36例）和对照组（39例）,两组患儿均给予哮喘常规治疗。治疗组在常规治疗的基础上给予GABA口服 (每日25~30 mg/kg）。采用酶联免疫吸附法（ELISA）测定患儿治疗前、缓解后血浆SP、CGRP的含量。结果：两组患儿治疗前血浆SP、CGRP含量差异无统计学意义（P＞0.05）;哮喘缓解后治疗组血浆SP、CGRP含量分别为57±15 pg/mL、23±10 pg/mL,显著低于对照组（分别为127±12 pg/mL、 42±8 pg/mL）,差异有统计学意义（P<0.01）。两组哮喘缓解后血浆SP、CGRP含量均较治疗前明显下降,差异有统计学意义（P<0.01）。哮喘患儿血浆SP与CGRP含量呈显著正相关（r=0.792,P<0.01）。结论：GABA可抑制小儿哮喘急性发作期血浆SP、CGRP的释放。     

Increased serum high-sensitivity C-reactive protein is related to hypoxia and brain natriuretic peptide in congenital heart disease

Background: Studies of adults have shown a direct association between increased serum concentrations of high-sensitivity C-reactive protein (hs-CRP) and atherosclerotic cardiovascular disease, diabetes, and chronic heart failure. Some studies have documented elevated hs-CRP in obese children and adolescents, and in patients with a history of Kawasaki disease, but there are few data on its clinical significance in congenital heart disease.
Methods: Measurements of hs-CRP, brain natriuretic peptide (BNP), hemoglobin, and percutaneous oxygen saturation (SpO2) were done in the following 70 patients: 18 controls; 11 with hypoxia (SpO2 ≤ 85% and BNP < 40 pg/mL); 31 with raised BNP (BNP ≥ 40 pg/mL and SpO2 > 85%); and 10 patients with hypoxia–BNP (SpO2 ≤ 85% and BNP ≥ 40 pg/mL). Correlations between hs-CRP, and age, body mass index (BMI), hemoglobin, SpO2, and BNP were analyzed using single and multiple regression analysis.
Results: Hs-CRP in the hypoxia–BNP group was higher than in the other three groups, while in the hypoxia and the BNP groups it tended to be higher than in the controls. Although single regression analysis showed significant correlations between hs-CRP and, age, BNP, hemoglobin, and SpO2, multiple regression analysis showed that only BNP and SpO2 had a significant correlation with hs-CRP.
Conclusions: In preoperative or postoperative congenital heart disease, patients who had hypoxia or increased BNP had a higher hs-CRP level than controls. Serum concentration of hs-CRP significantly correlated with SpO2 and plasma BNP levels, but not with age or BMI.     

Clinical implication of plasma natriuretic peptides in children with ventricular septal defect

BACKGROUND: There is little information available concerning plasma concentrations of B-type natriuretic peptide (BNP) in children with a ventricular septal defect. The aim of the present study was to determine hemodynamic factors that control plasma concentrations of BNP and the clinical implications of BNP compared with atrial natriuretic peptide (ANP) in children with ventricular septal defect. METHODS: Fifty-nine patients with ventricular septal defect (28 boys and 31 girls) without pulmonary vascular disease were enrolled. The patients' ages ranged from 3 months to 13 years (mean 3.1 years). Plasma BNP and ANP were determined by immunoradiometric assay. Hemodynamic variables derived from cardiac catheterization were analyzed in terms of correlation with BNP and ANP. RESULTS: It was found that plasma BNP significantly positively correlated with ANP (ANP = 2.1 x BNP + 25 pg/mL; r = 0.81, P < 0.0001) and BNP never exceeded ANP in the present patient series. Plasma BNP as well as ANP significantly positively correlated with pulmonary to systemic flow ratio (r = 0.65 and r = 0.59, respectively) and mean pulmonary artery pressure (r = 0.72 and r = 0.68, respectively). In addition, plasma BNP of > or =20 pg/mL and ANP of > or =50 pg/mL identified children with mean pulmonary artery pressure of > or =20 mmHg with a sensitivity of 82% and 97%, respectively, and a specificity of 89% and 84%, respectively. CONCLUSION: Plasma BNP and ANP reflect pressure and volume loads to the pulmonary artery and right ventricle and may help to identify children with ventricular septal defect complicated by pulmonary hypertension that demands early intervention.     

B-type natriuretic peptide to predict ductus intervention in infants <28 weeks

Patent ductus arteriosus (PDA) is frequent in neonates with gestational age of less than 28 wk. Clinical and echocardiographic signs define hemodynamic significance of PDA, but do not reveal the need for PDA intervention in the first days of life. B-type natriuretic peptide (BNP) has been proposed as a screening tool for PDA in preterm infants. To determine whether BNP can predict the need for PDA intervention, plasma BNP was measured by chemiluminescence immunoassay in 67 preterm infants <28 wk (median 26) on the second day of life in a prospective blinded study. PDA intervention was based on specified clinical and echocardiographic findings. Twenty-four patients (intervention group) received treatment for PDA and 43 patients (controls) remained without intervention. BNP concentrations were higher in the intervention (median 1069 pg/mL) than in the control group (247 pg/mL, p < 0.001). BNP correlated positively with ductal size (R = 0.46, p < 0.001) and atrial/aortic root ratio (R = 0.54, p < 0.001). In conclusion, plasma BNP proved to be a good predictor for ductus intervention (area under the curve: 0.86) with the best cutoff at 550 pg/mL on the second day of life in ventilated infants less than 28 wk gestation (sensitivity: 83%; specificity: 86%).     

Decreasing ratio of plasma N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide according to age

BACKGROUND: B-type natriuretic peptide (BNP) and the N-terminal fragment of proBNP (NT-proBNP) seem to be useful diagnostic tools also in children with cardiac disease. Recent data suggest that plasma levels of both peptides show different patterns from infancy to adolescence. AIM: To investigate the relationship of BNP and NT-proBNP in children and adolescents according to age. SUBJECTS AND METHODS: In 46 individuals without cardiac disease (22 males, 24 females, aged 0.4-17.5 years) and 30 patients with congenital heart disease (17 males, 13 females, aged 0.2-18.4 years), plasma levels of BNP and NT-proBNP were measured in the same sample (triage BNP assay, Biosite and Elecsys NT-proBNP assay, Roche Diagnostics). RESULTS: The range of BNP plasma levels was 5-32 pg/ml in individuals without heart disease and 5-1300 pg/ml in the patient group, the range of NT-proBNP was 10-298 pg/ml and 30-18,966 pg/ml, respectively. In both groups, the ratio NT-proBNP/BNP decreased with increasing age (P<0.001). CONCLUSION: Although proBNP is cleaved into the two fragments NT-proBNP and BNP, there is a decreasing ratio of NT-proBNP/BNP with increasing age caused probably by age-dependent differences in the metabolic clearance of both peptides. This has to be considered in comparison studies on BNP and NT-proBNP regarding their benefit to paediatric cardiology.     

Utility of B-Type Natriuretic Peptide in Differentiating Congestive Heart Failure from Lung Disease in Pediatric Patients with Respiratory Distress

Plasma B-type natriuretic peptide (BNP) has been reported to be helpful in differentiating cardiac from pulmonary etiologies of dyspnea in adults. We investigated whether BNP concentration could be applied similarly in children with respiratory distress. BNP levels were measured using a rapid immunoassay in 49 infants and children presenting with acute respiratory distress. The patients history, symptoms, physical exam, chest x-ray, and an echocardiogram were used to identify patients with congestive heart failure (CHF) from noncardiac causes of respiratory distress. Results are reported as mean ± SD. Patients with CHF (n = 23) had BNP levels of 693.0 ± 501.6 pg/ml, significantly higher than those of the group of patients with lung disease (n = 26), whose BNP was 45.2 ± 64.0 pg/ml (p < 0.001). There was no significant difference in age between the two groups (29.7 ± 59.3 vs 13.1 ± 22.6 months; p = 0.12). A BNP level of 40 pg/ml was 84% accurate in differentiating CHF from pulmonary disease. Fifteen of 23 CHF patients had ventricular volume overload from left-to-right shunting congenital heart defects and 8/23 had left ventricular systolic dysfunction. Age-adjusted comparison of the two subgroups of CHF patients revealed that children with left ventricular systolic dysfunction had significantly higher mean BNP levels than those with left-to-right shunts (1181 ± 487 vs 433 ± 471 pg/ml, p = 0.0074). We conclude that BNP level is of value in differentiating cardiac from pulmonary causes of respiratory distress in children.     

多普勒超声心动图对先天性心脏病合并肺动脉高压儿童左室形态与功能的评价

目的：探讨多普勒超声心动图对先天性心脏病（CHD）儿童肺动脉高压（PAH）的诊断价值及PAH对左室重塑和舒张功能（LVDF）的影响。方法：对彩色多普勒超声心动图证实的45例继发肺动脉高压的先天性心脏病患儿的超声心动图和多普勒血流资料与22例无PAH的先天性心脏病患儿（对照组）对比分析。结果：PAH组及对照组的左室舒张末内径分别为18.24±1.71 mm vs 16.28±0.52 mm、右室内径 12.23±2.14 mm vs 8.14±0.73 mm、肺动脉内径 11.20±1.35 mm vs 7.92±0.21 mm。两组比较差异有显著性（P<0.05）；VTR 流速增快（2.56±0.46）m/s及PASP压力（40.23±4.56）mmHg升高 ，与对照组相比差异亦有显著性（P<0.05）；室间隔增厚与对照组相比差异不明显。对照组、PAH组的二尖瓣口血流多普勒频谱A峰流速分别为94.56±31.45 m/s vs 51.17±26.67 m/s、A峰流速速度时间积分为10.89±2.73 s vs 4.94±1.85 s及AV/EV为1.79±0.32 vs 0.59±0.19、AVTI/EVTI为1.61±0.49 vs 0.45±0.21 两组比较差异有显著性(P<0.01)。左室等容舒张时间分别为119. 86±54.62 s vs 52.31±28.06 s。PAH组明显延长(P<0.05)。E峰流速、E峰流速速度时间积分及E峰减速时间两组无明显改变(P>0.05)。而增高的肺动脉压与二尖瓣口血流频谱AV/EV比值呈正相关,相关系数 r=0.4 456， P<0.01。结论：多普勒超声心动图不仅是先天性心脏病儿童合并肺动脉高压最重要的诊断方法之一，还可提供肺动脉高压对左室重塑和舒张功能受损的指标，对临床判断病情轻重及预后有重要价值。［中国当代儿科杂志，2007，9（5）：422-424］     

High-sensitivity C-reactive protein in children at risk for coronary artery disease

AIM: To determine the value of high-sensitivity C-reactive protein (hs-CRP) in predicting risk factors for coronary heart disease (CHD) in children. METHODS: We measured hs-CRP levels in 51 children (11.79 +/- 3.14 years) with risk factors for CHD (hypercholesterolemia, hypertension, obesity, low HDL cholesterol and familial history of CHD). The results were compared with 26 children (12.98 +/- 2.59 years) without any risk factors. RESULTS: The children with risk factors had significantly higher serum levels of hs-CRP compared to the control group (3.33 +/- 4.58 vs. 0.92 +/- 1.90 mg/L, respectively, p < 0.01). CRP concentrations significantly increased in children with three or more risk factors. Hs-CRP levels correlated to body mass index (r = 0.411, p = 0.003), diastolic blood pressure (r = 0.323, p = 0.021), fibrinogen (r = 0.447 and p = 0.004) and HDL cholesterol levels (r =-0.461 and p = 0.001). Cutoff value for CRP was 1.04 mg/L with 58% sensitivity and 92% specificity. CONCLUSION: Serum hs-CRP level is a useful marker in screening the children who are under the risk of CHD in adulthood. Early identification of the children with risk factors and intervention for obesity, harmful habits and life style in childhood might decrease the incidence of coronary heart disease in adulthood.     

Cardiac function in survivors of acute lymphoblastic leukaemia and Hodgkin's lymphoma

Aim: The study objective was to assess plasma N‐terminal–pro‐brain natriuretic peptide (BNP) levels and to evaluate left ventricular mass as well as left ventricular systolic and diastolic functions in 44 children who had undergone treatment for acute lymphoblastic leukaemia and Hodgkin's lymphoma, with regard to gender, age at disease onset, time that had passed since therapy completion, cumulative dose of antracyclines and mediastinal radiotherapy applied. Methods: The median levels of pro‐BNP were found to be higher in the whole study group as compared with the control (55.9 ± 53.1 ng/mL vs. 38.5 ± 47.7 ng/mL, P= 0.059). The pro‐BNP values >80.0 ng/mL (standard deviation score (SDS)) were noted in 11/44 patients, including those exceeding 115.0 ng/mL (2 SDS) – in 6/44 patients. Results: No correlation was observed of pro‐BNP levels with the accumulated dose of antracyclines (r=?0.42, P= 0.79) or mediastinal radiotherapy (r= 0.197, P= 0.2). However, negative correlation was found between pro‐BNP and the time that had passed since therapy completion (r=?0.378, P= 0.009). In echocardiography, shortening and ejection fractions remained normal, whereas the indexed stroke volume was below 40 mL/m² in 16/44 patients. The E/A index below 1.5 was found in 6/44 cases. The left ventricular systolic mass remained within the normal range. Negative correlation was noted between isovolumetric diastolic time and pro‐BNP level. Conclusions: Increased levels of pro‐BNP after anti‐cancer treatment with the involvement of cardiotoxic substances may indicate the first symptoms of myocardial dysfunction, despite the lack of major echocardiographic disorders.