血清BNP、CK-MB、H-FABP水平早期动态检测对先心病合并肺炎患儿病情评估的临床价值

目的研究血清脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)及心肌型脂肪酸结合蛋白(H-FABP)水平的早期动态检测在评估先天性心脏病(CHD)合并肺炎患儿病情中的作用。方法前瞻性选取解放军总医院第三医学中心2014年1月至2019年1月间收治的267例CHD合并肺炎患儿纳为研究组,同时将同期收治80例单纯肺炎患儿纳为对照组。检测两组患儿血清BNP、CK-MB及H-FABP水平。并根据研究组患儿是否并发心力衰竭(HF),将其分为HF组与无HF(NHF)组;根据HF严重程度,将研究组并发HF患儿分为轻、中、重度组;根据研究组并发HF患儿治疗情况,将其分为治疗前与治疗后。分别比较不同分组患儿血清BNP、CK-MB及H-FABP水平。最后绘制ROC曲线,分析以上血清物质在诊断先CHD合并肺炎患儿病情中的价值。结果研究组患儿入组时血清BNP、CK-MB及HFABP水平均显著高于对照组(P<0.05);研究组CHD合并肺炎患儿HF发生率为47.19%;HF组患儿BNP、CK-MB及H-FABP水平显著高于NHF组(P<0.05);随着心力衰竭程度的加重,HF组患儿血清BNP、CK-MB及H-FABP水平呈依次上升趋势,轻度组、中度组及重度组间差异显著(P<0.05);HF组患儿治疗后,其血清BNP、CK-MB及H-FABP水平均较入组时显著降低(P<0.05);绘制ROC曲线提示,血清BNP、CK-MB及H-FABP单独应用于CHD合并肺炎患儿心力衰竭中以BNP诊断效能最高AUC=0.883,95%CI(0.838~0.919)],三者联合应用能有效提高诊断各物质单独应用的价值AUC=0.949,95%CI(0.904~0.993)]。结论并发心衰的CHD合并肺炎患儿血清BNP、CK-MB及H-FABP浓度均明显高于无心衰者且随着心衰程度的加重,其血清BNP、CK-MB及H-FABP浓度均呈依次上升趋势绘制ROC曲线发现,各物质单独应用时,以BNP诊断HF的效能最高,而三者联合应用能有效提高CHD合并肺炎患儿并发HF的诊断价值。

Clinical value of early dynamic detection of serum BNP,CK-MB and H-FABP levels in evaluating the condition of children with congenital heart disease and pneumonia

Objective To investigate the clinical value of early dynamic detection of serum brain natriuretic peptide(BNP),Creatine kinase isoenzyme MB(CK-MB),and heart fatty acid-binding protein(H-FABP) levels in evaluating the condition of children with congenital heart disease(CHD) and pneumonia.Methods 267 CHD children with pneumonia(study group) and 80 pneumonia children(control group)in the hospital from January 2014 to January 2019 were included.The serum BNP,CK-MB and H-FABP levels were detected in two groups.Study group was further divided into two groups according to the presence or absence of heart failure,HF group and NHF group,then the HF group was divided into three groups according to the severity of HF,mild group,moderate group and severe group.Serum BNP,CK-MB and H-FABP levels were also compared between subgroups.ROC curve was drawn to analyze the value of the above serum indicators in the diagnosis of children with CHD and pneumonia.Results The levels of serum BNP,CK-MB and H-FABP were significantly higher in the study group than those in the control group(P <0.05).The incidence of HF in the study group was 47.19%;the levels of BNP,CK-MB and H-FABP in the HF group were significantly higher than those in the NHF group(P <0.05).With the aggravation of heart failure,the serum BNP,CK-MB and H-FABP levels showed an increasing trend in HF group,with statistic difference among mild group,moderate group and severe group(P <0.05).After treatment,the serum levels of BNP,CK-MB and H-FABP in the HF group were decreased(P <0.05).ROC curve indicated that BNP had the highest diagnostic efficacy in the single detection of three indicators for the heart failure in CHD children with pneumonia(AUC=0.883,95% CI 0.838-0.919),and the combined detection of the three could significantly diagnostic efficacy for the heart failure in CHD children with pneumonia(AUC=0.949,95% CI 0.904~0.993).Conclusion Serum levels of BNP,CK-MB and H-FABP of CHD and pneumonia children with heart failure are higher than those without heart failure,and the levels of the three are positively correlated with the severity of heart failure,moreover,ROC curve indicates that the BNP has the highest diagnostic efficacy in the single detection,while the diagnostic efficacy of combined detection of the three is higher than that of the single detection.