BNP对左向右分流型小儿先天性心脏病心功能评价

目的探讨脑钠肽（BNP）在左向右分流型小儿先天性心脏病（CHD）心功能评估中的价值。方法应用ELISA法测定67例左向右分型CHD病儿和10例正常对照组儿童血浆BNP水平,观察其与心功能分级、左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）的相关性。结果根据NYHA和改良Ross评分将左向右分流型CHD病儿分为心功能Ⅰ级（16例）、心功能Ⅱ级（28例）、心功能Ⅲ级（15例）和心功能Ⅳ级（8例）。与正常对照组比较,左向右分流型CHD病儿血浆BNP水平明显升高,差异有显著性（t=10.32,P〈0.01）。左向右分流型CHD病儿血浆BNP水平与心功能分级呈正相关（r=0.724,P〈0.01）。血浆BNP水平诊断心力衰竭的ROC曲线下面积为0.908,按照ROC曲线选取的诊断界值≥213ng/L。左向右分流型CHD病儿血浆BNP水平与LVEF、LVFS均无明显相关性（P均〉0.05）。结论血浆BNP水平与左向右分流型CHD病儿心功能密切相关,是评价心功能的有效指标,是诊断左向右分流型CHD病儿早期心力衰竭和无症状心力衰竭的敏感指标。

VALUE OF BRAIN NATRIURETIC PEPTIDE IN EVALUATION OF CADIAC FUNCTION IN CHILDREN WITH LEFT-TO-RIGHT SHUNT CONGENITAL HEART DISEASE

Objective To investigate the value of plasma brain natriuretic peptide（BNP）in functional assessment of children with left-to-right shunt congenital heart disease（CHD）. Methods ELISA was used to measure the plasma concentrations of BNP in 67children with left-to-right shunt CHD and 10healthy ones.The relationship between plasma BNP and cardiac function,left ventricular ejection fraction（LVEF）and left ventricular fractional shortening（LVFS）were observed. Results According to the NYHA and modified ROSS score,children with left-to-right shunt CHD were divided into NYHA classⅠ（16cases）,NYHA classⅡ（28cases）,NYHA classⅢ（15cases）and NYHAⅣ（8cases）.Compared with normal children,the plasma BNP in the sick children was elevated（t=10.32,P〈0.01）,which was positively correlated with cardiac functional grading（r=0.724,P〈0.01）.The area under the ROC curve of BNP was 0.908,and the cut-off line was≥213ng/L.The plasma BNP in the sick children was not obviously associated with LVEF or LVFS（P〉0.05）. Conclusion Plasma level of BNP is closely related with the cardiac function of children with left-to-right shunt congenital heart disease,which is a level of significance for evaluating heart function and a sensitive marker in diagnosing early and asymptomatic heart failure in children with this type of congenital heart disease.