内皮素在左向右分流型先天性心脏病肺动脉高压中作用的研究

为探讨内皮素在左向右分流型先天性心脏病（简称先心病）肺动脉高压（简称肺高压）中的作用，采用放射免疫法测定５２例肺高压和１１例非肺高压先心病患儿腔静脉和肺动脉血浆内皮素（ｉｒＥＴ－１）水平，并对其中１０例肺高压患儿进行肺活检免疫细胞化学染色。结果，肺高压患儿肺动脉和腔静脉血浆ｉｒＥＴ－１水平均随肺动脉压力升高而增加，并高于非肺高压患儿（Ｆ＝２．９５；３．３９，Ｐ＜０．０５）。肺高压患儿血浆ｉｒＥＴ－１与肺动脉压力及阻力成正相关（ｒ＝０．６５；０．５８，Ｐ＜０．０１）。肺高压患儿肌性和弹性肺小动脉ｉｒＥＴ－１染色明显加深。研究提示，左向右分流型先心病患儿内皮素产生的增加可导致肺高压患儿肺血管的中膜肥厚和内膜增生，促进了肺高压的发展。     

慢性心力衰竭患儿内皮素与降钙素基因相关肽的临床研究

为探讨内皮素（ＥＴ）、降钙素基因相关肽（ＣＧＲＰ）在慢性心力衰竭（简称心衰）中的作用，用放免法测定３８例心衰患儿与３０例心功能正常儿童血浆ＥＴ与ＣＧＲＰ水平。发现心衰时ＥＴ升高，ＣＧＲＰ降低（Ｐ均＜０．０１）。心功能越差，ＥＴ升高越明显。不同病因所致的心衰，其ＥＴ、ＣＧＲＰ水平无显著性差异。心衰时ＥＴ与ＣＧＲＰ呈显著负相关（ｒ＝－０．６４，Ｐ＜０．０１）。提示，ＥＴ、ＣＧＲＰ是参与心衰发病的重要体液因素，二者之间失衡可能是心衰发生、发展的重要原因。     

川崎病血液流变学的初步探讨

为探讨川崎病（ＫＤ）血液流变学改变，采用血液比粘度计检测了７８例ＫＤ患儿急性期与药物治疗１５天后的血粘度。结果：（１）急性期与对照组比较，全血低切粘度、血浆粘度（Ｖｐ）、血沉方程Ｋ值（ＥＳＲ－Ｋ）、红细胞聚集指数、红细胞电泳时间及纤维蛋白原（Ｆｉｂ）明显增高（Ｐ＜０．０１）；红细胞压积（ＨＣＴ）显著降低（Ｐ＜０．０１）。（２）药物治疗１５天后血液流变学指标明显改善，而Ｖｐ、ＥＳＲ－Ｋ仍增高（Ｐ＜０．０１）；ＨＣＴ仍降低（Ｐ＜０．０１）。（３）ＫＤ血粘度增高的主要原因是红细胞聚集性和Ｖｐ增高，后者与Ｆｉｂ、脂质过氧化物及免疫球蛋白呈正相关。研究表明ＫＤ患儿存在高粘、高聚、高凝、低血浓度状态。阿司匹林、复方丹参有抗粘、抗凝疗效，宜较长时间应用。     

先天性心脏病患儿血浆内皮素及降钙素基因相关肽的临床研究

目的　了解先天性心脏病患儿血浆降钙素基因相关肽（ＣＧＲＰ）及血浆内皮素（ＥＴ）的变化,探讨其在先天性心脏病继发的病理生理改变中的作用及其临床意义。方法　左向右分流型先天性心脏病患儿２９ 例,其中１１例成功地行修补术,正常对照组２５ 例。用放射免疫均相竟争法分别检测血浆ＣＧＲＰ及ＥＴ水平。结果　先天性心脏病患儿术前血浆ＣＧＲＰ较对照组低（Ｐ＜ ０．０１）,而ＥＴ较对照组高（Ｐ＜ ０．０１）;患儿术后血浆ＣＧＲＰ较术前有增高趋势,但差异不显著（Ｐ＞ ０．０５）,而其ＥＴ 较术前低（Ｐ＜ ０．０５）;先天性心脏病患儿血浆ＣＧＲＰ与ＥＴ成直线负相关（ｒ＝ － ０．７１　Ｐ＜ ０．０１）。结论　左向右分流型先天性心脏病患儿血浆ＣＧＲＰ的降低与ＥＴ的增高可能共同参与了肺动脉高压的形成。     

心肌疾病抗ADP/ATP载体抗体与粒细胞-巨噬细胞集落刺激因子的临床研究

目的探讨病毒性心肌炎（ＶＭＣ）和扩张型心肌病（ＤＣＭ）的自身免疫发病机制。方法采用免疫印转和放射免疫技术检测了３０例ＶＭＣ、１４例ＤＣＭ患儿血浆中抗心肌线粒体ＡＤＰ／ＡＴＰ运载蛋白（ＡＮＴ）抗体和粒细胞－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）。结果ＶＭＣ和ＤＣＭ患儿抗ＡＮＴ抗体和ＧＭ－ＣＳＦ的阳性率分别为７３％和５７％，而２５例正常健康儿分别为０和１２％（Ｐ均＜０．０１），且抗ＡＮＴ抗体与ＧＭ－ＣＳＦ的血浆水平呈正相关（ｒ＝０．４０９１，Ｐ＜０．０５）。结论小儿ＶＭＣ和ＤＣＭ的发病与心肌的自身免疫损伤有关，抗ＡＮＴ抗体和ＧＭ－ＣＳＦ均参与了这一过程。抗ＡＮＴ抗体可作为小儿ＶＭＣ和ＤＣＭ的一种特异性诊断指标。     

支气管哮喘患儿T淋巴细胞及细胞因子的变化

为观察儿童支气管哮喘时Ｔ淋巴细胞亚群分布以及Ｔ细胞活化相关因子及受体的表达状况，应用放射免疫分析等技术，对３４例发作期、２５例缓解期支气管哮喘患儿和１５例正常对照的外周血Ｔ淋巴细胞亚群、血浆及淋巴细胞膜表面白细胞介素－２受体（ＩＬ－２Ｒ）和相关细胞因子等水平进行系统检测。结果：（１）发作期患儿外周血Ｔ细胞亚群ＣＤ３，ＣＤ４及ＣＤ４／ＣＤ８值与缓解期患儿及正常对照比较差异无显著意义，但发作期ＣＤ８高于正常对照（Ｐ＜０．０１）和缓解组（Ｐ＜０．０１）；（２）发作期患儿血浆可溶性ＩＬ－２Ｒ、（ｓＩＬ－２Ｒ）、ＩｇＥ水平明显高于缓解期患儿和正常对照（Ｐ＜０．０１）；（３）免疫电镜观察显示，发作期患儿淋巴细胞膜表面ＩＬ－２Ｒ表达高于正常对照（Ｐ＜０．０５）。提示：（１）哮喘患儿外周Ｔ淋巴细胞亚群的分布发生了变化，哮喘发作期Ｔ淋巴细胞处于激活状态；（２）血浆ｓＩＬ－２Ｒ、ＩｇＥ水平与哮喘病情变化密切相关，可作为临床哮喘病情监测的指标。     

巨细胞病毒肝炎患儿细胞免疫功能变化和干扰素的临床疗效

目的研究巨细胞病毒（ＨＣＭＶ）肝炎患儿细胞免疫功能是否受损；经治疗后临床症状恢复期中免疫功能的恢复情况；干扰素对巨细胞病毒肝炎的疗效。方法用ＤＮＡ探针斑点原位杂交，酶兔方法检查ＨＣＭＶ抗原，尿中分离ＨＣＭＶ３种方法诊断ＨＣＭＶ肝炎。用ＩＬ－２活性测定、Ｔ细胞亚群测定检测患儿细胞免疫功能，将患儿分为干扰素加维生素Ｃ、肌苷治疗组（γＩＦＮ）和仅用维生素Ｃ、肌苷治疗组（非γＩＦＮ），连续观察３个月临床症状恢复情况。结果ＨＣＭＶ肝炎患儿有明显的细胞免疫功能损伤，且临床症状缓解后部份免疫功能尚不能完全恢复。干扰素治疗组的临床症状恢复和第１月与第２月的痊愈率明显优于无干扰素治疗组。黄疸消退平均提前１４．９天（Ｐ＜０．０５）；肝肿大恢复正常提前２８．４天（Ｐ＜０．０１），ＳＧＰＴ恢复正常平均提前１４．９天（Ｐ＜０．０１）。两组的第１月与第２月痊愈率分别为４８．６％与２０．６％、８８．６％与４７．１％（Ｐ＜０．０５）。结论ＨＣＭＶ患儿细胞免疫功能均受损，且不能随症状好转而立即全部好转。干扰素能使ＨＣＭＶ患儿的临床症状加快消退。     

缺氧缺血性脑病新生儿血浆内皮素和降钙素基因相关肽水平动态观察

目的探讨内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）在新生儿缺氧缺血性脑病（ＨＩＥ）中的变化及临床意义。方法采用放射免疫法对３６例ＨＩＥ患儿和１８例健康足月新生儿血浆ＥＴ和ＣＧＲＰ水平进行了同期动态测定。结果ＨＩＥ患儿急性期血浆ＥＴ和ＣＧＲＰ水平较恢复期明显增高（Ｐ＜０．０１）,并明显高于同期对照组水平（Ｐ＜０．０１）,恢复期与正常对照组无显著性差异。急性期不同程度ＨＩＥ及对照组之间ＥＴ,ＣＧＲＰ水平比较表明,重度组明显高于对照组、轻度组及中度组,中度组高于对照组和轻度组,轻度组与对照组无显著性差异。急性期患儿血浆ＥＴ和ＣＧＲＰ呈直线正相关（ｒ＝０．３８,Ｐ＜０．０５）。结论ＥＴ和ＣＧＲＰ参与了新生儿缺氧缺血性脑病的病理生理过程。ＥＴ的增高可能是促发ＨＩＥ脑损伤的一个重要因素,而ＣＧＲＰ增高在ＨＩＥ病程中对脑损伤可能具有一定保护作用。     

缺氧缺血性脑病新生儿血浆内皮素和降钙素基因相关肽水平动态观察

目的探讨内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）在新生儿缺氧缺血性脑病（ＨＩＥ）中的变化及临床意义。方法采用放射免疫法对３６例ＨＩＥ患儿和１８例健康足月新生儿血浆ＥＴ和ＣＧＲＰ水平进行了同期动态测定。结果ＨＩＥ患儿急性期血浆ＥＴ和ＣＧＲＰ水平较恢复期明显增高（Ｐ＜０．０１）,并明显高于同期对照组水平（Ｐ＜０．０１）,恢复期与正常对照组无显著性差异。急性期不同程度ＨＩＥ及对照组之间ＥＴ,ＣＧＲＰ水平比较表明,重度组明显高于对照组、轻度组及中度组,中度组高于对照组和轻度组,轻度组与对照组无显著性差异。急性期患儿血浆ＥＴ和ＣＧＲＰ呈直线正相关（ｒ＝０．３８,Ｐ＜０．０５）。结论ＥＴ和ＣＧＲＰ参与了新生儿缺氧缺血性脑病的病理生理过程。ＥＴ的增高可能是促发ＨＩＥ脑损伤的一个重要因素,而ＣＧＲＰ增高在ＨＩＥ病程中对脑损伤可能具有一定保护作用。     

哮喘患儿血浆降。钙素基因相关肽与内皮素水平相关研究

用放免分析法，对１８例婴幼儿哮喘患儿血浆降钙素基因相关肽（ｃａｌｃｉｔｏｎｉｎｇｅｎｅ－ｒｅｌａｔｅｄｐｅｐｔｉｄｅ，ＣＧＲＰ）及内皮素（ＥＴ）水平做了同期动态测定。结果哮喘急性发作期血浆ＣＧＲＰ含量较其临床缓解期、轻型肺炎组及正常对照组均显著降低（Ｐ＜０．０１）；而同期测定血浆ＥＴ含量的变化规律则与之相反，即哮喘急性发作期ＥＴ含量明显高于其临床缓解期、轻型肺炎组和正常对照组（Ｐ＜０．０１），统计学处理显示血浆ＣＧＲＰ与ＥＴ间呈显著负相关（Ｐ＜０．０５）。提示血浆ＣＧＲＰ含量降低和ＥＴ含量增高对婴幼儿哮喘的发生发展可能有一定的促进作用。还对其可能的作用机理进行了探讨。     

Levels of circulating endothelial cells and colony-forming units are influenced by age and dyslipidemia

Background:The balance between endothelial injury and repair in childhood is poorly understood. We examined this relationship in healthy children, in adults, and in children with familial hypercholesterolemia (FH).Methods:Circulating endothelial cells (CECs) were measured as a marker of vascular injury, with vascular repair assessed by counting colony-forming units (CFUs), also known as endothelial progenitor cells.Results:CEC number increased with age. Children with FH had elevated CECs as compared with healthy children, with similar levels numerically to those found in healthy adults. CFU numbers were higher in healthy children than either healthy adults or children with FH. Endothelium-dependent vascular function, measured by flow-mediated dilatations, was positively associated with CFU number, even after adjustment for confounding risk variables.Conclusion:Levels of CECs increase and CFUs decrease with age. In childhood, before the onset of clinically detectable cardiovascular dysfunction, children with a major risk factor for atherosclerotic disease have levels of these indexes of vascular injury and repair approaching those seen in adults.     

Aminoterminal Brain Natriuretic Peptide Levels in Children and Adolescents After Fontan Operation Correlate with Congestive Heart Failure

The aim of this study was to generate normal values of amino-terminal pro-brain natriuretic peptide (NT-pro-BNP) in children and adolescents after Fontan operation without congestive heart failure (CHF) and to test the hypothesis that plasma levels of NT-pro-BNP correlate with the clinical severity of CHF. NT-pro-BNP plasma levels of 59 consecutive patients, with a median age of 8.4 years, after Fontan operation were measured using an automated enzyme immunoassay. The 97.5th percentile of NT-pro-BNP in patients without CHF was 282.3 pg/ml. The severity of heart failure was quantified by a pediatric cardiologist using the New York University Pediatric Heart Failure Index (NYUPHFI). NT-pro-BNP levels correlated with the NYUPHFI (p = 0.001). In patients with CHF (14/59) the NT-pro-BNP levels were significantly higher (median, 399 pg/ml; range, 140-5440 pg/ml) than in patients without CHF (median, 96 pg/ml; range, 11-376 pg/ml). NT-pro-BNP levels of patients with Fontan circulation without CHF are similar to those of healthy children. Plasma NT-pro-BNP concentrations correlate with the severity of CHF in children and adolescents after Fontan operation. Plasma NT-pro-BNP levels can help clinicians in the detection of CHF in pediatric patients with Fontan circulation.     

Plasma endothelin concentration: Relation with vascular resistance and comparison before and after balloon dilatation procedures

Endothelin (ET) is a potent vasoconstrictor peptide with an as yet uncertain physiological role in cardiovascular disease. We measured blood plasma ET concentrations using a recently developed radioimmunoassay and analysed the relations between ET concentration, systemic arterial pressure and systemic vascular resistance. In addition, ET levels before and after percutaneous balloon valvuloplasty and angioplasty were measured. Fifty-one patients were studied: (1) 13 patients with small left-to-right shunting or Kawasaki heart disease (age ranged from 4 to 144 months); (2) 10 patients who had undergone ballon valvuloplasty or angioplasty (age ranged from 1 to 233 months) and (3) 28 healthy infants and children (age ranged from 3 to 152 months). Systemic vascular resistance was calculated by the formula (mean aortic pressure — mean right atrial pressure) X 80/cardiac output (dyne·sec·cm^–5). Plasma ET concentrations in healthy children less than 2 years were significantly higher than those over 2 years (2.48±0.62 vs 1.31±0.53 pg/ml). In eight patients in groups 1 and 2, plasma ET concentration in the pulmonary artery (2.00±0.43 pg/ml) was significantly lower than that in the femoral vein (2.39±0.69 pg/ml) and aorta (2.23±0.59 pg/ml), suggesting ET secretion derived from endothelial cells in peripheral pulmonary vessels. There was a significant positive correlation between ET concentrations in the femoral vein and systemic vascular resistance (r=0.55,p<0.05). After balloon dilatation ET concentration rose from 2.15±0.82pg/ml to 2.61±1.38 pg/ml. These results suggest that ET may be a stress-induced hormone which is secreted by the transient hypotension following percutaneous balloon dilatation and which regulates peripheral vascular tonus.     

急性呼吸窘迫综合征患儿气道吸出物内皮素-1、白细胞介素-8检测的意义

目的探讨内皮素-1(ET-1)和白细胞介素-8(IL-8)在急性呼吸窘迫综合征(ARDS)中的作用。方法采用酶联免疫吸附法(ELISA)检测ARDS 13例及对照组11例气道吸出物(TA)中ET-1、IL-8浓度,并对所有患儿进行肺损伤评分(LIS)。结果ARDs组TA中ET-1、IL-8含量较对照组显著增高(P<0.01),死亡组TA中ET-1、IL-8水平显著高于存活组(P<0.01),LIS评分与ET-1、IL-8水平呈显著正相关(P<0.01)。结论ET-1、IL-8参与ARDS发病过程,早期测定肺内ET 1、IL-8水平可作为判断其肺损伤严重程度和预后的指标。     

Comparison of Endothelial Biomarkers According to Reversibility of Pulmonary Hypertension Secondary to Congenital Heart Disease

The reversibility of pulmonary arterial hypertension (PAH) in children with congenital heart disease (CHD) is strongly associated with the degree of intimal proliferation, vessel narrowing, and number of circulating endothelial cells (CECs). Circulating endothelial cells may arise from either endothelial damage or accelerated turnover during vessel remodeling, but nothing is known about endothelial microparticles (EMPs) and other biomarkers reflecting endothelial alterations. This study aimed to document endothelial markers further according to the irreversibility of PAH secondary to CHD. The study investigated soluble markers of endothelial damage or activation (thrombomodulin, soluble endothelial protein C receptor, and soluble E-selectin), inflammation (interleukin-6), and angiogenic cytokine levels [vascular endothelial growth factor (VEGF) and placental growth factor (PlGF)] in 26 patients with CHD, 16 with reversible PAH (median age, 2 years) and 10 with irreversible PAH (median age, 9 years). Endothelial activation/apoptosis was evaluated by measuring EMP levels. Plasma procoagulant activity also was measured. The results show that the levels of soluble markers indicating endothelial activation were not predictors of PAH irreversibility. Lower levels of PlGF were observed in reversible compared with irreversible PAH but were not associated with the CEC level, the mean pulmonary artery pressure (mPAP), or age. No significant difference in procoagulant activity or EMP level was found between irreversible and reversible PAH. Among a large panel of biomarkers reflecting endothelial activation, regeneration, and injury, the high CEC levels previously described proved to be the only marker allowing discrimination between reversible and irreversible PAH secondary to CHD.     

心内膜弹力纤维增生症患儿降钙素基因相关肽和内皮素的变化及其临床意义

为探讨降钙素基因相关肽（CGRP）、内皮素（ET）在心内膜弹力纤维增生症（EFE）中的作用。应用放射免疫法测定18例EFE患儿血浆CGRP和ET水平,X线胸片测心胸比率（CTR）,彩色超声心动图检测心脏收缩功能。结果表明：EFE患儿血浆CGRP降低而ET升高,CGRP与ET呈负相关;经治疗病情好转后,血浆CGRP回升而ET下降;EFE患儿血浆CGRP、ET与CTR及心脏收缩功能有关。本研究提示,CGRP降低和ET升高两者协同作用可能是促进EFE心衰发生发展的原因之一。EFE患儿血浆CGRP、ET监测为估计病情、预后和疗效判断提供客观参考依据;治疗EFE时应重视纠正失衡的体液因子水平。     

急性心力衰竭患儿血浆脑钠素及心钠素水平的变化

目的探讨急性心力衰竭患儿血浆脑钠素(BNP)及心钠素(ANP)水平变化及其意义。方法选择不同病因的充血性心力衰竭(CHF)患儿46例及肺炎患儿40例、先天性心脏病患儿31例、健康儿童40例,应用酶联免疫吸附法分别检测血浆BNP及ANP水平,用多普勒超声心动图测量心力衰竭患儿心衰期及恢复期心脏指数(CI)及左室射血分数(LVEF)。结果CHF患儿心衰前期BNP即开始升高,心衰时达高峰(P<0.001),恢复期BNP水平渐下降,但仍高于正常值(P<0.001);心衰时心脏CI、LVEF均明显下降(P<0.01);CHF患儿心衰时升高的BNP水平与CI、LVEF均呈明显负相关(r=-0.61,0.79P均<0.05);同时测定的ANP动态变化趋势与BNP类似;CHF患儿心衰时的BNP/ANP比值远远高于正常对照;心衰时BNP与ANP异常率比较有显著差异(P<0.05);心衰时BNP水平与LVEF、CI值相关性优于ANP。结论CHF患儿血清BNP及ANP水平明显升高.且与心衰程度关系密切,BNP反映心脏功能改变较ANP更敏感,更具有特异性。     

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目的探讨儿童阻塞性睡眠呼吸暂停综合征(OSAS)患儿血浆内皮素1(ET1)和血管紧张素Ⅱ(AngⅡ)水平的变化及临床意义。方法选择广州市2004年2月至2004年11月在儿童医院住院治疗的80例OSAS患儿及30例正常儿童,测定血浆ET1及AngⅡ水平。结果与正常儿童相比,OSAS患儿血浆ET1及AngⅡ水平明显增高,差异有统计学意义(P<0.05)。ET1水平对多导睡眠图(PSG)结果无明显影响;AngⅡ浓度与最低SaO2相关。结论血浆ET1和AngⅡ水平增加与OSAS发病有一定的关系。     

慢性充血性心力衰竭患儿血浆儿茶酚胺、心钠素水平的意义

目的探讨慢性充血性心力衰竭（CHF）患儿血浆儿茶酚胺（CA）[包括肾上腺素（E）、去甲肾上腺素（NE）]、心钠素（ANP）水平变化及其与心脏左室功能的关系。方法选择CHF患儿及正常对照组各35例，测定其血浆NE、E及ANP水平，检测左室射血分数（LVEF）。结果1．CHF组治疗前血浆NE、E、ANP水平显著高于正常对照组，二组比较差异有显著性（Pa〈0．01）。2．CHF组治疗前显著高于抗心力衰竭综合治疗心力衰竭好转后血浆NE、E、ANP水平，二组比较差异有显著性（Pa〈0．01）。3．CHF组治疗后血浆NE、E、ANP水平显著高于正常对照组，二组比较差异有统计学意义（Pa〈0．05）。4．CHF组心功能越差，血浆NE、E、ANP升高越明显，差异有显著性（P〈0．01）。5．以35例CHF患儿血浆NE、E、ANP为自变量，LVEF为应变量作直线相关分析，显示CHF组血浆NE、E、ANP与LVEF呈显著负相关。结论CA、ANP水平与CHF程度密切相关，心功能下降可能与CA、ANP水平过度生成有关，其可作为评价CHF的指标之一。     

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。