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。     

心力衰竭患儿血浆脑钠肽变化及临床意义

目的 探讨心力衰竭患儿血浆脑钠肽(BNP)变化及其与心功能的关系.方法 研究对象为2005年4月至2007年1月在宜宾市第二人民医院住院的心力衰竭患儿43例,应用ELISA方法测定患儿血浆BNP浓度,M型超声心动图测量左室射血分数(LVEF)、短轴缩短率(FS),并比较BNP与LVEF、FS的相关性.结果与正常对照组比较,心力衰竭患儿血浆BNP水平明显升高,心功能参数LVEF、FS显著降低(t值分别为8.092、3.780、3.864.P值分别<0.001、<0.01、<0.01).心衰程度越重.血浆BNP水平升高越明显(F=4.26,P<0.01).心功能Ⅰ级组患儿血浆BNP水平已明显升高(t=4.708,P<0.01),心功能参数LVEF、FS降低不明显.不同原发病心力衰竭患儿血浆BNP无差别.血浆BNP水平与LVEF和FS存在负相关关系(r分别为-0.568,-0.325,P值分别<0.05,<0.001).结论 心衰惠儿血浆BNP水平显著升高,随着患儿心衰程度加重,血浆BNP水平增高越显著.血浆BNP水平是心衰患儿心脏功能更敏感的生化指标.     

脑钠素与肌钙蛋白I在小儿心力衰竭诊断、预后评估中的意义

目的 探讨血浆脑钠素(BNP)、肌钙蛋白I(CTnI)水平变化在小儿心力衰竭(CHF)患儿诊断、预后评估中的意义.方法 选择心力衰竭患儿41例,根据ROSS心功能分期将CHF患儿分为心衰早期、心衰期、恢复期.41例健康体检者作为对照组.分别采用放射免疫分析法和化学发光免疫分析法检测各组血浆BNP及CTnI水平;同时观察血浆BNP水平与CHF患儿预后的关系.结果 心衰早期患儿血浆BNP、CTnI即开始升高,心衰期达高峰,恢复期逐渐下降,但仍显著高于正常对照组(P＜0.01).心衰早期、恢复期患儿血浆BNP阳性率(92.7%,90.2%)较CTnI阳性率(63.4%,58.5%)有显著性差异(P＜0.01);BNP持续＞500 ng/L的心脏事件发生率(66.7%)明显高于BNP＜500 ng/L的心脏事件发生率(21.4%)(P＜0.01).结论 BNP、CTnI可反映心肌损伤程度;血浆BNP在心衰早期诊断方面其敏感性及特异性均优于CTnI,血浆BNP可作为诊断和判定小儿心衰预后的重要参考依据之一.     

慢性心力衰竭患儿血清心型脂肪酸结合蛋白、可溶性ST2蛋白变化及意义

目的探讨慢性心力衰竭(CHF)患儿血清心型脂肪酸结合蛋白(H-FABP)、可溶性ST2蛋白(s ST2)水平变化及临床意义。方法选择39例CHF患儿为研究对象,并以健康体检儿童30例为对照组。采用酶联免疫吸附法(ELISA)检测血清H-FABP及s ST2,心脏超声测量左室射血分数(LVEF)及左室短轴收缩率(LVFS)。结果 39例CHF患儿中男15例、女24例,年龄2月~14岁,包括心内膜弹力纤维增生症(EFE)27例,扩张型心肌病(DCM)12例。按心功能分级标准分为心功能Ⅱ级10例,Ⅲ级15例,Ⅳ级14例。CHF患儿心衰期及心衰缓解期血清H-FABP、s ST2、NT-Pro-BNP与对照组比较,差异有统计学意义(χ2=22.57~69.54,P均0.01)。心衰期血清H-FABP、s ST2在心功能Ⅱ级、Ⅲ级、Ⅳ级三组间任意两组比较差异有统计学意义(χ2=21.03、20.28,P均0.05)。EFE、DCM两组间比较血清H-FABP、s ST2水平差异无统计学意义(t=0.289、0.678,P均0.05)。经Spearman相关分析显示,CHF患儿心衰期血清H-FABP与NT-Pro-BNP、s ST2、心功能级别呈正相关(r=0.402~0.644,P均0.05);s ST2与NT-Pro-BNP、心功能级别呈正相关(r=0.501、0.678,P均0.05),与LVEF、LVFS呈负相关(r=-0.340、-0.329,P均0.05);结论H-FABP与s ST2均参与了心力衰竭的发生发展过程,H-FABP和s ST2可能可作为临床诊断和评估CHF的参考指标。     

川崎病患儿血浆脑利钠肽水平改变及其与心功能的关系

目的：探讨脑利钠肽(BNP) 在川崎病(KD)患儿血浆中的变化及其与心功能的关系。方法：选择KD患儿43例作为观察组（KD组）,30例健康儿童作为对照组。对KD急性期、恢复期患儿及对照组儿童采用酶联免疫吸附法测定血浆BNP浓度,KD组常规超声心动图检测左室射血分数(LVEF)、左室短轴缩短率（LVSF）、心脏指数（CI）及舒张期二尖瓣血流频谱速度（E/A）。结果：KD患儿急性期血浆BNP水平明显高于恢复期及对照组,差异有统计学意义(P<0.01)。急性期LVEF、LVSF、CI较恢复期降低,差异有统计学意义（P<0.05）。直线相关分析显示,KD患儿急性期血浆BNP水平与LVEF、LVSF、CI均呈负相关（r=-0.63,-0.52,-0.53,P<0.05）。结论：血浆BNP浓度在KD急性期异常升高,与左室收缩功能呈负相关。血浆BNP水平检测对KD的早期诊断具有重要意义。［中国当代儿科杂志,2010,12（3）：169-171］     

支气管肺炎患儿血清脑钠肽水平与心功能的相关性

目的 探讨支气管肺炎患儿心功能状态与血清脑钠肽(BNP)水平的相关性.方法选取支气管肺炎患儿52例.其中并心力衰竭(心衰)患儿20例.男9例,女11例;年龄4个月～4岁.未并心衰患儿32例.男17例,女15例;年龄6个月～5岁.健康对照组婴幼儿30例.男16例,女14例;年龄6个月～5岁.3组儿童均抽取静脉血离心后留取血清,采用ELISA法测定其血清BNP水平,采用全自动生化分析仪测定其CK-MB水平,同时应用心脏超声诊断仪测定及计算心功能指标.结果支气管肺炎并心衰患儿血清BNP水平[(182.45±57.32) ng/L]、CK-MB水平[(48.19±16.08) IU/L],均高于健康对照组[(35.12±13.84) ng/L、(11.48±4.29) IU/L] (Pa＜0.01),支气管肺炎未并心衰患儿血清BNP及CK-MB水平分别为(43.69±19.55) ng/L、(13.06±5.64) IU/L,与健康对照组比较,均无显著性差异(Pa＞0.05).支气管肺炎并心衰患儿左心室射血分数(LVEF)、左室小轴缩短率(FS)、主动脉峰值流速(PFVA)及肺动脉峰值流速(PFVP)均较健康对照组明显降低(Pa＜0.01),支气管肺炎未并心衰患儿与健康对照组比较,均无显著性差异(Pa＞0.05).血清BNP水平与CK-MB水平呈正相关(r=0.28P＜0.05),与LVEF 、FS、PFVA、PFVP均呈负相关(r=-0.65,-0.58,-0.32Pa<0.01;r=-0.39P<0.05).血清CK-MB与LVEF、FS均呈负相关(r=-0.30,-0.26Pa＜0.05),与PFVA、PFVP均无相关性(Pa＞0.05).结论血清BNP水平可作为支气管肺炎患儿并心衰的实验室指标.     

脑钠肽和氨基末端脑钠肽在小儿先天性心脏病心功能评估中的价值

目的：探讨脑钠肽（BNP）和氨基末端脑钠肽（NT-proBNP）在小儿先天性心脏病心功能评估中的价值。方法：71例先天性心脏病患儿分为无心力衰竭组和心衰组;35例正常儿童作为对照组。应用微粒子酶免疫分析法和电化学发光法分别测定血浆BNP和NT-proBNP浓度。同时测定左室舒张末期内径指数（LVEDDI）、左室射血分数（LVEF）。结果：心衰组血浆BNP和NT-proBNP水平明显高于无心衰组(均P<0.01);无心衰组血浆BNP和NT-proBNP水平明显高于对照组(均P<0.01) 。心衰组血浆LogBNP和LogNT-proBNP水平与LVEF均呈负相关(r=-0.64,-0.67,均P<0.01);二者水平与LVEDDI均呈正相关（r=0.58,0.76,均P<0.01）。无心衰组血浆LogBNP和LogNT-proBNP水平与LVEF均无明显相关性;血浆LogNT-proBNP水平与LVEDDI呈正相关（r=0.35,P<0.05）。分别以BNP≥149.8 pg/mL,NT-proBNP≥820.1 pg/mL作为充血性心力衰竭的诊断阈值,二者的敏感度分别为87.0％,91.3％,特异度分别为91.7％,97.9％,ROC曲线下面积分别为0.935,0.987。结论：BNP和NT-proBNP均可用于先天性心脏病患儿心功能的评估,并可用于该类患儿充血性心力衰竭的诊断;与BNP比较,NT-proBNP诊断心衰的价值更高。［中国当代儿科杂志,2009,11（6）：429-432］     

慢性心力衰竭患儿血清心型脂肪酸结合蛋白、可溶性ST2蛋白变化及意义北大核心CSCD

目的：探讨慢性心力衰竭（CHF）患儿血清心型脂肪酸结合蛋白（H-FABP）、可溶性ST2蛋白（sST2）水平变化及临床意义。方法选择39例CHF患儿为研究对象,并以健康体检儿童30例为对照组。采用酶联免疫吸附法（ELISA）检测血清H-FABP及sST2,心脏超声测量左室射血分数（LVEF）及左室短轴收缩率（LVFS）。结果39例CHF患儿中男15例、女24例,年龄2月～14岁,包括心内膜弹力纤维增生症（EFE）27例,扩张型心肌病（DCM）12例。按心功能分级标准分为心功能Ⅱ级10例,Ⅲ级15例,Ⅳ级14例。CHF患儿心衰期及心衰缓解期血清H-FABP、sST2、NT-Pro-BNP与对照组比较,差异有统计学意义（χ2=22.57~69.54,P均＜0.01）。心衰期血清H-FABP、sST2在心功能Ⅱ级、Ⅲ级、Ⅳ级三组间任意两组比较差异有统计学意义（χ2=21.03、20.28,P均＜0.05）。EFE、DCM两组间比较血清H-FABP、sST2水平差异无统计学意义（t=0.289、0.678,P均＜0.05）。经Spearman相关分析显示,CHF患儿心衰期血清H-FABP与NT-Pro-BNP、sST2、心功能级别呈正相关（r=0.402～0.644,P均＜0.05）;sST2与NT-Pro-BNP、心功能级别呈正相关（r=0.501、0.678,P均＞0.05）,与LVEF、LVFS呈负相关（r=－0.340、－0.329,P均＜0.05）;结论 H-FABP与sST2均参与了心力衰竭的发生发展过程,H-FABP和sST2可能可作为临床诊断和评估CHF的参考指标。     

脑钠素与肌钙蛋白Ⅰ在小儿心力衰竭诊断、预后评估中的意义

目的探讨血浆脑钠素（BNP）、肌钙蛋白Ⅰ（CTnI）水平变化在小儿心力衰竭（CHF）患儿诊断、预后评估中的意义。方法选择心力衰竭患儿41例，根据ROSS心功能分期将CHF患儿分为心衰早期、心衰期、恢复期。41例健康体检者作为对照组。分别采用放射免疫分析法和化学发光免疫分析法检测各组血浆BNP及CTnI水平；同时观察血浆BNP水平与CHF患儿预后的关系。结果心衰早期患儿血浆BNP、CTnI即开始升高，心衰期达高峰，恢复期逐渐下降，但仍显著高于正常对照组（P〈0．01）。心衰早期、恢复期患儿血浆BNP阳性率（92．7％，90．2％）较CTnI阳性率（63．4％，58．5％）有显著性差异（P〈0．01）；BNP持续〉500ng／L的心脏事件发生率（66．7％）明显高于BNP〈500ng/L的心脏事件发生率（21．4％）（P〈0．01）。结论BNP、CTnI可反映心肌损伤程度；血浆BNP在心衰早期诊断方面其敏感性及特异性均优于CTnI，血浆BNP可作为诊断和判定小儿心衰预后的重要参考依据之一。     

重症肺炎合并心力衰竭患儿血清肌酸激酶同工酶、脑利钠肽及神经肽Y水平变化

目的探讨重症肺炎合并心力衰竭患儿血清肌酸激酶同工酶(CK-MB)、脑利钠肽(BNP)和神经肽Y(NPY)水平的变化。方法入选2010年12月至2014年12月住院普通肺炎患儿32例(普通组),重症肺炎患儿20例(重症组),重症肺炎合并心力衰竭患儿36例(心衰组),以及健康体检儿童26例(对照组),采用酶速率法在ADVIA1650全自动生化分析上测定CK-MB,酶联免疫吸附试验(ELISA)方法检测BNP及NPY的水平,其中18例重症肺炎合并心力衰竭患儿在恢复期再次检测。结果四组间血清CK-MB、BNP和NPY水平比较,差异均有统计学意义(F=25.19~277.94,P均0.01)。心衰组患儿血清CK-MB、BNP和NPY浓度均高于重症组、普通组和对照组,差异有统计学意义(P均0.05);重症组血清CK-MB浓度高于普通组和对照组,差异有统计学意义(P均0.05);普通组与对照组CK-MB浓度比较差异无统计学意义(P0.05);重症组、普通组和对照组三组间血清BNP和NPY浓度比较,差异均无统计学意义(P均0.05)。心衰组18例患儿治疗后的血清CK-MB、BNP和NPY水平均低于治疗前,差异有统计学意义(P均0.001)。心衰组血清BNP水平与CKMB、NPY水平均呈显著正相关(r=0.681、0.525,P均0.01);NPY与CK-MB水平亦呈显著正相关(r=0.545,P0.01)。结论血清CK-MB、BNP及NPY浓度检测有助于诊断儿童重症肺炎合并心衰,其中BNP更为敏感。     

Pulmonary Gastrin-Releasing Peptide Expression in Anencephaly

Gastrin-releasing peptide (GRP) is a developmentally regulated bioactive peptide believed to function as a pulmonary growth factor. It is produced by pulmonary neuroendocrine cells, found within the conducting and respiratory epithelium, as isolated cells and in clusters known as neuroepithelial bodies (NEBs). Deficient GRP expression has been reported in pulmonary hypoplasia (PH) associated with oligohydramnios and diaphragmatic hernia. To assess further the role of GRP in maldeveloped lung we reviewed the postmortem records and histologic lung sections, stained with H&E and anti-GRP antiserum, from 11 infants with anencephaly and 11 age-matched controls. Cells immunoreactive for GRP were quantified (isolated versus NEBs) in airways and airspaces per mm² for a standard area. PH was present in five anencephalic infants. There was no difference in the total number of GRP-positive cells, number of NEBs, size of NEBs, or number of GRP-positive cells in airways or alveoli in either group regardless of lung development. A greater proportion of the GRP-positive cells was present in the airways in anencephalic infants with PH (58%) compared with anencephalic infants without PH (40%) (P = .018). There were no differences when comparing these groups with control infants and no differences in the density of airways in each of these groups. We conclude that deficient GRP expression is not a feature of lung hypoplasia in anencephalic infants. The altered distribution of GRP-positive cells in anencephalic infants with PH may be a reflection of the structural abnormalities or accompanying altered cellular maturity.     

缺氧缺血性脑病新生儿血浆神经肽Y和降钙素基因相关肽的变化

目的：研究缺氧缺血性脑病新生儿血浆神经肽Y(NPY)和降钙素基因相关肽(CGRR)的变化。方法：采用放免法动态观察42例中度HIE患儿和30例正常对照组NPY和CGRP在急性期和恢复期的变化以及与脑血流的相关性。结果：观察组NPY总体水平高于对照组,尤以窒息后第2,3天为著[(168.3±10.9)ng/L vs(86.7±5.4)ng/L],差异有显著性(P<0.01);观察组CGRP总体水平低于对照组,尤以窒息后第2,3天为著[(48.4±3.7)ng/L vs(81.3±16.8)ng/L],差异有显著性(P<0.01)。结论：NPY,CGRP在HIE的发病机理中可能起重要的作用,参与了HIE的发生和发展;HIE第2～3天脑血管痉挛收缩,是应用扩血管治疗的最佳时期。     

Amino-Terminal Pro-B-Type Natriuretic Peptide in Refractory Kawasaki Disease

Serum concentrations of brain natriuretic peptide and its amino-terminal cleavage pro-fragment, NT-proBNP, have never been reported in refractory Kawasaki disease. Changes in NT-proBNP levels after infliximab treatment in an infant with severe cardiovascular complications are reported here. The regular evaluation of this cardiac biomarker after infliximab treatment may have clinical relevance in patients with refractory Kawasaki disease and severe heart involvement.     

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.     

Atrial Natriuretic Peptide and Extracellular Volume Contraction after Birth

ABSTRACT. Plasma concentrations of atrial natriuretic peptide (ANP) were measured in full-term newborns immediately after birth and on the 3rd, 5th, 7th and 10th day of life. The ANP concentrations were within the normal range in the first hours of life. Plasma concentrations of ANP had increased significantly on the 3rd and 5th day of life, while body weight decreased continuously. After the 5th day of life ANP concentration decreased continuously reaching its minimum on the 10th day whereas body weight increased. The mechanism behind ANP release shortly after birth is not known. The increase in ANP concentration in plasma may however induce changes in body fluid compartments shortly after birth which would result in physiological weight loss.     

缺氧缺血性脑病新生儿内皮素、降钙素基因相关肽、心钠素及血清钠、钙的变化

目的探讨HIE患儿血浆内皮素(ET)、降钙素基因相关肽(CGRP)及心钠素(ANP)的变化及其临床意义。方法应用放射免疫分析法和离子交换法测定46例HIE和26例正常新生儿的血浆ET、CGRP、ANP和血清钠、钙水平。结果HIE组急性期血浆ET、CGRP和ANP水平明显高于对照组及恢复期组(P均<0.001));病情越重,ET、CGRP和ANP水平越高,恢复期血浆ET、CGRP和ANP水平渐下降,中重度组下降的幅度更为缓慢。HIE中重度组血钠水平明显低于对照组(P<0.05);不同程度HIE组血钙水平均明显低于对照组,差异显著(P<0.01)。HIE组治疗前后血浆ET与CGRP、ANP水平呈直线正相关,急性期血浆ET与血钙、血浆ANP与血钠之间无明显相关性(P均>0.05)。结论血浆ET、CGRP和ANP共同参与HIE发病机制及病理过程,其动态变化有助于病情判断、疗效评价及预后评估。     

胸腺素治疗特发性血小板减少性紫癜

目的　总结胸腺素治疗特发性血小板减少性紫癜 (ITP)的经验。方法　对同期确诊ITP患儿 1 0 4例随机分为治疗组和对照组 ,治疗组采用胸腺素 4mg/ (kg·d) ,肌肉注射 1次 /d ,疗程 1～ 3个月 ;对照组口服泼尼松 1～ 2mg/ (kg·d) ,3次 /d ,口服。结果　治疗组和对照组总有效率、起效时间 ,T细胞亚群中CD4/CD8变化及不良反应均有显著差异 (P <0 .0 5)。结论　胸腺素治疗ITP ,疗效满意。