N 端脑利钠肽前体对新生儿窒息合并心肌损伤诊断的临床价值

目的：探讨N端脑利钠肽前体（Nt‐proBNP）在新生儿窒息合并心肌损伤患儿中的变化，评估其临床应用价值。方法选择该科收住的58例出生24 h内的足月窒息新生儿为研究对象，其中轻度窒息33例（心肌损伤15例），重度窒息25例（心肌损伤18例），窒息后非心肌损伤25例。选取同期出生24 h内入院生命体征平稳无窒息史及心血管系统疾病的足月新生儿25例为对照组，检测各组新生儿生后第1、3、5天血浆Nt‐proBNP、肌酸激酶同工酶（CK‐MB）质量并进行统计学分析。结果出生第1、3天，重度窒息心肌损伤组、轻度窒息心肌损伤组Nt‐proBNP均高于非心肌损伤组和对照组，重度窒息心肌损伤组高于轻度窒息心肌损伤组，差异均有统计学意义（P＜0．05）；出生第5天，重度窒息心肌损伤组Nt‐proBNP仍然高于其他各组，差异有统计学意义（P＜0．05），轻度窒息心肌损伤组Nt‐proBNP与非心肌损伤组和对照组比较，差异无统计学意义（P＞0．05）。出生后第1天轻度窒息心肌损伤、重度窒息心肌损伤患儿血浆Nt‐proBNP 与CK‐MB质量呈正相关（r＝0．58、0．47，P＜0．05）。出生第1天，心肌损伤患儿血浆 Nt‐proBNP的诊断值为695．87 fmol／mL 时，ROC曲线下面积为0．763，敏感度为71．9％，特异度为65．4％，阳性预测值73．3％，阴性预测值63．8％。结论对窒息新生儿进行血浆 Nt‐proBNP水平检测，有助于早期评估窒息后心肌损伤的严重程度，具有较重要的临床应用价值。

Clinical value of N-terminal pro-brain natriuretic peptide in the diagnosis of myocardial injury after asphyxia of newborns

Objective To investigate the changes and clinical significance of plasma N‐terminal pro‐brain natriuretic peptide (Nt‐proBNP) in patients with asphyxia of newborns combined with myocardial injury .Methods Fifty‐eight term neonates with neonatal asphyxia born within 24 h were included in our study ,18 of the 25 severe asphyxia cases were combined with myocardial injury ,15 of 33 mild asphyxia cases were with myocardial injury ,there were 25 subjects were not cardiac injured after asphyxia to‐tally .Patients of the same age without asphyxia or any cardiovascular disease were recruited into the control group .Levels of plasma Nt‐proBNP and creatine kinase isoenzyme (CK‐MB) were detected on the first ,third and the fifth days after birth for statistical a‐nalysis .Results On the first and third days after birth ,levels of plasma Nt‐proBNP in severe and mild asphyxia combined with my‐ocardial injury group were significantly higher than the groups without myocardial injury and the control (P<0 .05) .Levels of plas‐ma Nt‐proBNP in severe asphyxia myocardial injured group were significantly higher than those of the mild asphyxia myocardial in‐jured ones (P<0 .05) .On the fifth day ,the levels of plasma Nt‐proBNP in severe asphyxia myocardial injured group were signifi‐cantly higher than others (P<0 .05) .There was no difference in Nt‐proBNP levels between mild asphyxia myocardial injured group and the ones without myocardial injury (P>0 .05) .On the first day after birth ,levels of Nt‐proBNP ,CK‐MB were positively corre‐lated in the mild asphyxia group (r=0 .58 ,P<0 .05) and severe asphyxia group (r=0 .47 ,P<0 .05) .On the first day after birth , the cutoff value for myocardial injury was 695 .87 fmol/mL ,the area under the ROC curve was 0 .763 ,with the sensitivity of 71 .9%and specificity of 65 .4% ,the positive predictive value was 73 .3% and negative predictive value was 63 .8% .Conclusion The Nt‐proBNP level has important clinical value for early evaluation of the severity of myocardial injury after asphyxia .